Intracranial Bleeds Flashcards
What are some risk factors of an intracranial bleed? (8)
• Head injuries
• Hypertension
• Aneurysms
• Ischaemic strokes (progressing to bleeding)
• Brain tumours
• Thrombocytopenia (low platelets)
• Bleeding disorders (e.g., haemophilia)
• Anticoagulants (e.g., DOACs or warfarin)
GCS score:
Patient localises to pain?
M5
GCS score:
Patient has normal flexion away from pain?
M4
GCS score:
Patient has a decorticate posture?
M3
Abnormal flexion to pain
Arms flexed hands at chin
GCS score:
Patient abnormally extends?
M2
Extends with arms by side
GCS score:
Patient speaking but confused?
V4
GCS score:
Patient speaking but inappropriate words?
V3
GCS score:
Patient making incomprehensible sounds?
V2
GCS score:
Eyes respond to speech?
E3
GCS score:
Eyes respond to pain?
E2
What bloods should be done in intracranial bleeds?
• Bloods should include a full blood count (for platelets) and a coagulation screen.
What are some surgical options for extradural and subdural Haematomas? (2)
○ Craniotomy (open surgery by removing a section of the skull)
○ Burr holes (small holes drilled in the skull to drain the blood)
Where do extradural haemorrhages occur?
• Occurs between the skull and dura mater
What artery is ruptured in extradural haemorrhage?
Middle meningeal artery
What is an extradural haemorrhage often associated with?
Fracture of the temporal bine
What shape is an extradural haemorrhage?
Biconvex
What is the typical patient with an extradural haemorrhage?
• Young patient with a traumatic head injury and an ongoing headache.
What is the typical presentation of an extradural haemorrhage?
• 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.
Where does a subdural haemorrhage occur?
• Occurs between the dura mater and arachnoid mater
What shape is a subdural haemorrhage?
Crescent shape
What is the typical patient with a subdural haemorrhage?
• Elderly and alcoholic patients, who have more atrophy in their brains, making the vessels more prone to rupture.
Where does a subarachnoid haemorrhage occur?
• Involves bleeding in the subarachnoid space, where the cerebrospinal fluid is located, between the pia mater and the arachnoid membrane.
What is usually the cause of a subarachnoid haemorrhage?
Ruptured cerebral aneurysm
What is the presentation of a subarachnoid haemorrhage?
• Sudden-onset occipital headache during strenuous activity, such as heavy lifting or sex.
• The sudden and severe onset leads to the “thunderclap headache” description.
When should LP be done after a subarachnoid haemorrhage?
> 12hours of onste
What is seen on an LP in a subarachnoid haemorrhage?
Xanthochromia
Yellowing of CSF from bilirubin
What is the typical presentation of an intracerebral haemorrhage?
• It presents similarly to an ischaemic stroke with sudden-onset focal neurological symptoms, such as limb or facial weakness, dysphasia or vision loss.
Where does an intracerebral haemorrhage occur?
• Intracerebral haemorrhage involves bleeding in the brain tissue.
