Intracranial Bleeds

Question 1

What are the 3 extra axial intracranial haemorrhages?

Answer 1

epi/extradural
subdural
subarachnoid

Question 2

What are the 2 intra axial intracranial haemorrhages?

Answer 2

intracerebral

intraventricular

Question 3

What does extra axial mean?

Answer 3

Within skull, outside brain tissue

Question 4

What does intra axial mean?

Answer 4

Within brain tissue

Question 5

What often causes extradural and subdural haemorrhages?

Answer 5

Trauma

e.g. assault, falls, car crash

Question 6

Where is the haemorrhage in extradural?

Answer 6

Between skull and dural membrane

Question 7

How does extradural haemorrhage present?

Answer 7

altered consciousness
headache 
N and V
Confusion 
seizures 
aphagia

Question 8

What is usually the source of bleeding in extradural haemorrhage?

Answer 8

Arterial

Question 9

How are extradural and subdural haemorrhages diagnosed?

Answer 9

CT head
extra dural - lens shaped
sub dural - crescent

Question 10

Where is the bleed in subdural haemorrhages?

Answer 10

Between dura and arachnoid

Question 11

What happens in 50% of subdural haemorrhages?

Answer 11

coma

Question 12

What is often the source of bleeding in subdural haemorrhaged?

Answer 12

bridging veins

Question 13

In what haemorrhage is Kernig’s sign positive?

Answer 13

Subarachnoid haemorrhage

Question 14

What is Kernig’s sign?

Answer 14

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.

Question 15

Where is the bleeding in subarachnoid haemorrhages?

Answer 15

in the subarachnoid space

Question 16

What is often the cause of subarachnoid haemorrhages?

Answer 16

rupture of saccular/berry aneurysm

Question 17

How does subdural haemorrhage often present?

Answer 17

Fluctuating level of consciousness 
Recent trauma 
headache 
N and V 
sleepiness, personality change

Question 18

What are the risk factors for subdural haemorrhage?

Answer 18

recent trauma
anti coagulants
coagulopathy
age >65

Question 19

What is the treatment of subdural haemorrhage?

Answer 19

Depends on size
<10mm, without significant neurological dysfunction - observation, follow up imaging
>10mm or significant neurological dysfunction or >5mm midline shift - surgery

Question 20

What is the presentation of subarachnoid haemorrhage?

Answer 20

thunderclap headache 
LOC
seizure
N and V
meningism e.g. stiff neck, photophobia

Question 21

What is contraindicated in epic/extradural haemorrhage?

Answer 21

LP

Question 22

What is the treatment of subarachnoid haemorrhage?

Answer 22

Surgery - clipping or coil embolism

CCB - nimodipine

Question 23

What is the presentation of an intracerebral haemorrhage?

Answer 23

Neurological signs and symptoms - depends on area
headache
N and V
Decreasing level of consciousness

Question 24

What is the second most common cause of stroke, after emboli?

Answer 24

Intracerebral haemorrhage

Question 25

What is an intraventricular haemorrhage?

Answer 25

Bleeding within ventricles - usually secondary to another haemorrhage e.g. when subarachnoid haemorrhage extends or intracerebral haemorrhage ruptures

Question 26

What shape is the haematoma on CT in extradural haemorrhages?

Answer 26

Lens/convex

Question 27

What is the management of extradural haemorrhages?

Answer 27

neurosurgery - clot evacuation and ligation

Question 28

IN which haemorrhage is a lucid interval often seen?

Answer 28

Extradural

Question 29

What is the trauma often like in subdural haemorrhages?

Answer 29

minor, often forgotten about

Question 30

What is associated with berry aneurysms?

Answer 30

polycystic kidney disease