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Neuro conditions > Intracranial bleed > Flashcards

Intracranial bleed Flashcards

1
Q

Risk factors for Intracerebral bleed?

A
  • head injury
  • aneurysm
  • ischaemic stroke –> can progress to haemorrhage
  • HT
  • brain tumour
  • anticoagulants ie warfarin
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2
Q

Presentation?

A
  • sudden onset headache
  • any sudden onset neurological symptoms
  • seizures
  • weakness
  • reduced consciousness
  • vomiting
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3
Q

how do you test for reduced consciousness?

A

GCS

  • <8 = coma
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4
Q

Outline the GCS

At what GCS score should you consider securing the airway?

A

Eyes

  • 4= Spontaneous
  • 3= Speech
  • 2= Pain
  • 1= None

Verbal

  • 5=Orientated
  • 4=Confused
  • 3=Inappropriate words
  • 2=Incomprehensible sounds
  • 1=None

Motor

  • 6= Obeys commands
  • 5= Localises to pain
  • 4= Withdraws from pain
  • 3= Flexion from pain
  • 2= Extension from pain
  • 1= None

8/15 or below

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5
Q

Subdural Haemorrhage

cause?

A

mainly due to rupture of the bridging veins in between dura and arachnoid mater

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6
Q

Subdural Haemorrhage

findings on CT?

A

crescent shape, not limited by cranial sutures

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7
Q

Subdural Haemorrhage

Aetiology?

A
  • Acute - due to severe brain injury
  • Chronic- mild injury often in elderly, alcoholics
    • have more atrophy in their brain and therefore vessels more prone to rupturing
    • because brain is atrophied, there is considerable room for heamatoma to expand before they cause symptoms
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8
Q

Subdural Haemorrhage

Rx

A

timely surgical evacuation

-this prevents the pathophysiological cycle which otherwise leads to ischaemia and neuronal death

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9
Q

what happens as intracranial pressure rises?

A

cerebral perfusion pressures and cerebral blood flow may fall –> ischaemic injury occurs

therefore very important to maintain CPP

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10
Q

how do you calculate cerebral perfusion pressure?

A

MAP-ICP= CPP

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11
Q

Extradural haemorrhage

Cause

A

Mainly due to rupture of middle meningeal artery, secondary to trauma (may be due to fractured temporal bone)

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12
Q

Extradural haemorrhage

Findings on CT?

A

bi-convex shape limited by the cranial sutures

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13
Q

Extradural haemorrhage

Presentation?

A

Usually following traumatic head injury, will present with ongoing headache

Period of improving neurological symptoms & consciousness, followed by a quick decline over hours. This is due to the haematoma becoming large enough to compress intracranial structures

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14
Q

Extradural haemorrhage

Rx?

A

immediate surgical decompression

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15
Q

What is an Intracerebral bleed?

Aetiology?

A

bleeding into the brain tissue

May be caused by….

  • spontaneous
  • ruptured aneurysm
  • bleeding into an ischaemic infarct
  • brain tumour
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16
Q

What is SAH

A

bleeding into Subarachnoid space, where CSF is located

17
Q

Aetiology of SAH

A

mainly due to rupture of cerebral aneurysm

18
Q

Prognosis of SAH

A

associated with high morbidity and mortality

19
Q

Presentation of SAH

A
  • thunderclap headache
    • like been hit in the back of the head with a bat
  • neck stiffness
  • photophobia
  • any other neurological symptoms
    • weakness, seizures, loss of consciousness, vision/speech changes
20
Q

Risk factors for SAH (& therefore for aneurysm)

A
  • FH
  • HT
  • smoking
  • excessive alcohol consumption
  • cocaine use
21
Q

Epidemiology of SAH

A
  • black people
  • females
  • 45-70y/o
22
Q

What is SAH associated with?

A
  • cocaine use
  • sickle cell anaemia
  • connective tissue disorders ie Marfan’s
  • neurofibromatosis
23
Q

Ix for SAH

A
  • CT scan - 1st line
    • hyperattenuation in subarachnoid space
    • could be normal
  • Lumbar Puncture if CT scan negative
    • raised red cell count
    • xanthochromia - yellow tinge to CSF due to billirubin
  • Angiography (CT or MRI) once SAH confirmed
    • to locate source of bleed
24
Q

Mx of SAH

A
  • transfer to specialist neurosurgical unit
  • if reduced consciousness –> intubate and ventilate
  • surgical treatment
    • coiling- endovascular repair
    • clipping - involves cranial surgery and putting a clip onto the aneurysm to seal it
  • Nimodipine - to prevent vasospasm
    • common complication of SAH causing ischaemia
  • Anti-epileptics - to treat seizures
  • LP/ shunt - treat hydrocephalus

Neuro conditions (28 decks)

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