Intracranial Bleeds

Question 1

What are the 4 main types of Intracranial bleeds?

Answer 1

1) Extradural Haemorrhage
2) Subdural Haemorrhage
3) Sub-Arachnoid
4) Intracerebral

Question 2

What is the cause and main features of an Extradural Haemorrhage?

Answer 2

Tear in the middle meningeal artery from a skull fracture
- Compression of brain
Treated by Immediate surgical drain

Question 3

What is the cause and main features of an Subdural Haemorrhage?

Answer 3

Trauma, with a fall leading to bleed from dural bridging veins
- Low pressure bleed with general ^ in ICP and affects those in old ages
Headache, drowsiness and confusion

Question 4

What is the PP behind a subdural Haemorrhage?

Answer 4

Latent delay after trauma, causes breakdown of clot 8-10 weeks later and increase in oncotic pressure
- Water sucked into haematoma by osmosis
- Increase in ICP
(Treated by surgical removal)

Question 5

What is the cause and main features of a sub-arachnoid Haemorrhage?

Answer 5

Spontaneous rupture of CA (Berry Aneurysm)

- Appears with a thunderclap headache and photophobia, reduced consciousness, neck stiffness, nausea and vomiting

Question 6

What investigations conducted for S-A H?

Answer 6

1. CT scan of head - would show blood in sulci.
2. Lumbar puncture.
3. MRA.
   Treatment: Bedrest/BP control, IV saline and CCB to prevent CA spasm

Question 7

What are the main features of an intracerebral haemorrhage?

Answer 7

Acute bleed appears with coma, confusion, seizure and weakness

Question 8

Give 2 primary causes of intra-cerebral haemorrhage.

Answer 8

1. Hypertension -> Berry or Charcot-Bouchard aneurysms -> rupture.
2. Lobar (amyloid angiopathy).

Question 9

Give 5 secondary causes of intra-cerebral haemorrhage.

Answer 9

1. Tumour.
2. Arterio-venous malformations (AVM).
3. Cerebral aneurysm.
4. Anticoagulants e.g. warfarin.
5. Haemorrhagic transformation infarct.

Question 10

Describe the treatment for anti-coagulant related intra-cerebral haemorrhage.

Answer 10

Check warfarin INR and consider reversal with vitamin K.

If low platelets, platelet transfusion.

Question 11

What is the likely cause of bleeds in the basal ganglia, pons and/or cerebellum?

Answer 11

Hypertension.

Question 12

Give 3 potential complications of Charcot-Bouchard aneurysms.

Answer 12

1. Rupture (haemorrhage).
2. Thrombosis.
3. Leakage (microbleeds).