Intracranial Bleeds

Question 1

Around ____% of strokes are caused by intracranial bleeds.

Answer 1

Around 10-20% of strokes are caused by intracranial bleeds.

Question 2

Q

Answer 2

A

Question 3

what are the risk factors for intracranial bleeds

Answer 3

Head injury
Hypertension
Aneurysms
Ischaemic stroke can progress to haemorrhage
Brain tumours
Anticoagulants such as warfarin

Question 4

how might an intracranial bleed present?

Answer 4

Sudden onset headache is a key feature. They can also present with:

Seizures
Weakness
Vomiting
Reduced consciousness
Other sudden onset neurological symptoms

Question 5

The _____________ is a universal assessment tool for assessing the level of consciousness

Answer 5

Glasgow Coma Scale (GCS)

Question 6

GCS is based on what?

Answer 6

eyes, verbal and motor response

Question 7

GCS max and min score?

Answer 7

max: 15/15
min 3/15

Question 8

When someone has a GCS score of ___/15 or below then you need to consider securing their airway as there is a risk they are not able to maintaining it on their own.

Answer 8

When someone has a score of 8/15 or below then you need to consider securing their airway as there is a risk they are not able to maintaining it on their own.

Question 9

how is the eyes bit of GCS assessed?

Answer 9

Eyes

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

Question 10

how is the Verbal bit of GCS assessed?

Answer 10

Verbal response

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

Question 11

how is the Motor bit of GCS assessed?

Answer 11

Motor response

Obeys commands = 6
Localises pain = 5
Normal flexion = 4
Abnormal flexion = 3
Extends = 2
None = 1

Question 12

Subdural haemorrhage is caused by …..

Answer 12

Subdural haemorrhage is caused by rupture of the bridging veins in the outermost meningeal layer. They occur between the dura mater and arachnoid mater

Question 13

On a CT scan subdural haemorrhages have… what appearance?

Answer 13

On a CT scan they have a crescent shape and are not limited by the cranial sutures (they can cross over the sutures).

Question 14

Subdural haemorrhages occur more frequently in who? and why?

Answer 14

Subdural haemorrhages occur more frequently in elderly or alcoholic patients.
These patients have more atrophy in their brains making vessels more likely to rupture.

Question 15

Extradural haemorrhage is usually caused by ……

Answer 15

Extradural haemorrhage is usually caused by rupture of the middle meningeal artery in the temporo-parietal region

Question 16

extradural haemorrhages are associated with?

Answer 16

It can be associated with a fracture of the temporal bone.

Question 17

gradual haemorrhages bleeding occurs where?

Answer 17

It occurs between the skull and dura mater

Question 18

on a CT scan an extradural haemorrhage looks like what?

Answer 18

On a CT scan they have a bi-convex shape and are limited by the cranial sutures (they can’t cross over the sutures).

Question 19

typical history for an extradural haemorrhage? how do the symptoms progress?

Answer 19

The typical history is a young patient with a traumatic head injury that has an ongoing headache. They have a period of improved neurological symptoms and consciousness followed by a rapid decline over hours as the haematoma gets large enough to compress the intracranial contents.

Question 20

Intracerebral haemorrhage involves bleeding into ….

Answer 20

Intracerebral haemorrhage involves bleeding into the brain tissue.

Question 21

Intracerebral haemorrhage involves bleeding into the brain tissue. It presents similarly to an ….

Answer 21

ischaemic stroke.

Question 22

where can intracerebral haemorrhage be seen

Answer 22

Anywhere in brain tissue:
Lobar intracerebral haemorrhage
Deep intracerebral haemorrhage
Intraventricular haemorrhage
Basal ganglia haemorrhage
Cerebellar haemorrhage

Question 23

intracerebral haemorrhages can occur due to:

Answer 23

They can occur spontaneously or as the result of bleeding into an ischaemic infarct or tumour or rupture of an aneurysm.

Question 24

Subarachnoid haemorrhage involves bleeding in to the …..

Answer 24

Subarachnoid haemorrhage involves bleeding in to the subarachnoid space, where the cerebrospinal fluid is located, between the pia mater and the arachnoid membrane.

Question 25

subarachnoid haemorrhages are usually the result of ….

Answer 25

This is usually the result of a ruptured cerebral aneurysm.

Question 26

typical history of a subarachnoid haemorrhage?

Answer 26

The typical history is a sudden onset occipital headache that occurs during strenuous activity such as weight lifting or sex. This occurs so suddenly and severely that it is known as a “thunderclap headache”.

Question 27

subarachnoid haemorrhage are associated with …

Answer 27

They are particularly associated with cocaine and sickle cell anaemia.

Question 28

give the principals of management of intracranial bleeds? (7)

Answer 28

Immediate CT head to establish the diagnosis
Check FBC and clotting
Admit to a specialist stroke unit
Discuss with a specialist neurosurgical centre to consider surgical treatment
Consider intubation, ventilation and ICU care if they have reduced consciousness
Correct any clotting abnormality
Correct severe hypertension but avoid hypotension

Question 29

End

Answer 29

End