Intracranial Bleeds Flashcards
What are the 3 extra axial intracranial haemorrhages?
epi/extradural
subdural
subarachnoid
What are the 2 intra axial intracranial haemorrhages?
intracerebral
intraventricular
What does extra axial mean?
Within skull, outside brain tissue
What does intra axial mean?
Within brain tissue
What often causes extradural and subdural haemorrhages?
Trauma
e.g. assault, falls, car crash
Where is the haemorrhage in extradural?
Between skull and dural membrane
How does extradural haemorrhage present?
altered consciousness headache N and V Confusion seizures aphagia
What is usually the source of bleeding in extradural haemorrhage?
Arterial
How are extradural and subdural haemorrhages diagnosed?
CT head
extra dural - lens shaped
sub dural - crescent
Where is the bleed in subdural haemorrhages?
Between dura and arachnoid
What happens in 50% of subdural haemorrhages?
coma
What is often the source of bleeding in subdural haemorrhaged?
bridging veins
In what haemorrhage is Kernig’s sign positive?
Subarachnoid haemorrhage
What is Kernig’s sign?
person lie flat on the back, flex the thigh so that it is at a right angle to the trunk, and completely extend the leg at the knee joint.
Where is the bleeding in subarachnoid haemorrhages?
in the subarachnoid space
What is often the cause of subarachnoid haemorrhages?
rupture of saccular/berry aneurysm
How does subdural haemorrhage often present?
Fluctuating level of consciousness Recent trauma headache N and V sleepiness, personality change
What are the risk factors for subdural haemorrhage?
recent trauma
anti coagulants
coagulopathy
age >65
What is the treatment of subdural haemorrhage?
Depends on size
<10mm, without significant neurological dysfunction - observation, follow up imaging
>10mm or significant neurological dysfunction or >5mm midline shift - surgery
What is the presentation of subarachnoid haemorrhage?
thunderclap headache LOC seizure N and V meningism e.g. stiff neck, photophobia
What is contraindicated in epic/extradural haemorrhage?
LP
What is the treatment of subarachnoid haemorrhage?
Surgery - clipping or coil embolism
CCB - nimodipine
What is the presentation of an intracerebral haemorrhage?
Neurological signs and symptoms - depends on area
headache
N and V
Decreasing level of consciousness
What is the second most common cause of stroke, after emboli?
Intracerebral haemorrhage
What is an intraventricular haemorrhage?
Bleeding within ventricles - usually secondary to another haemorrhage e.g. when subarachnoid haemorrhage extends or intracerebral haemorrhage ruptures
What shape is the haematoma on CT in extradural haemorrhages?
Lens/convex
What is the management of extradural haemorrhages?
neurosurgery - clot evacuation and ligation
IN which haemorrhage is a lucid interval often seen?
Extradural
What is the trauma often like in subdural haemorrhages?
minor, often forgotten about
What is associated with berry aneurysms?
polycystic kidney disease
