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Neurology > Intracranial bleeds > Flashcards

Intracranial bleeds Flashcards

1
Q

What are the risk factors for intracranial bleeds

A 
Head injury
Hypertension
Aneurysms
Ischaemic stroke can progress to haemorrhage
Brain tumours
Anticoagulants such as warfarin
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2
Q

What are features of an intracranial bleed

A
  • sudden onset
  • Seizures
  • Weakness
  • Vomiting
  • Reduced consciousness
  • Other sudden onset neurological symptoms
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3
Q

What are ‘eyes’ marked out of in GCS score

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

What is ‘motor’ marked out of in the GCS score

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

What is ‘verbal response’ marked out of in the GCS score

A 
Orientated = 5
Confused conversation = 4
Inappropriate words = 3
Incomprehensible sounds = 2
None = 1
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6
Q

What is a subdural haemorrhage

A
  • rupture of the bridging veins in the outermost meningeal layer
  • between the dura mater and arachnoid mater
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7
Q

Who are most at risk for subdural haemorrhages

A
  • alcoholics
  • Elderly
  • More atrophy of brain so veins rupture more easily
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8
Q

What is an extradural haemorrhage

A
  • Rupture of the middle meningeal artery in the temporo-parietal region
  • fracture of the temporal bone
  • between the skull and dura mater
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9
Q

What do you see on CT scan in a subdural haemorrhage

A

Crescent shape and are NOT limited by the cranial sutures (they can cross over the sutures).

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10
Q

What do you see on CT scan in extra dural haemorrhage

A

Bi-convex shape and are limited by the cranial sutures (they can’t cross over the sutures).

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11
Q

What is the typical history seen in an extra-dural haemorrhage

A
  • Young patient with head trauma and ongoing bleed

- Period of lucidity before dropping their GCS as haematoma compresses the brain

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12
Q

Which regions can you have a haemorrhagic stroke

A 
Lobar intracerebral haemorrhage
Deep intracerebral haemorrhage
Intraventricular haemorrhage
Basal ganglia haemorrhage
Cerebellar haemorrhage
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13
Q

What is a subarachnoid haemorrhage

A
  • bleeding in to the subarachnoid space, where the cerebrospinal fluid is located
  • between the pia mater and the arachnoid membrane.
  • Usually ruptured cerebral aneurysm.
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14
Q

What is the typical history of a subarachnoid haemorrhage

A
  • Sudden onset occipital headache
  • Neck stiffness
  • Photophobia
  • Vision changes
  • Neurological symptoms such as speech changes, weakness, seizures and loss of consciousness
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15
Q

What are the risk factors of subarachnoid haemorrhage

A 
Hypertension
Smoking
Excessive alcohol consumption
Cocaine use
Family history
Sickle cell anaemia
Connective tissue disorders ( Marfan syndrome or Ehlers-Danlos)
Neurofibromatosis
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16
Q

What demographic of patients is subarachnoid haemorrhage associated with

A

Black patients
Female patients
Age 45-70

17
Q

What investigations should be completed if worried about subarachnoid haemorrhage

A
  • CT head
  • LP- If CT negative
  • Angiograpghy: source of bleeding
18
Q

What would you see on CT in subarachnoid haemorrhage

A

Blood will cause hyperattenuation in the subarachnoid space.

19
Q

What would you see on LP in subarachnoid haemorrhage

A
  • Red cell count will be raised. If the cell count is decreasing in number over the samples, this could be due to a traumatic lumbar puncture.
  • Xanthochromia (the yellow colour of CSF caused by bilirubin)
20
Q

What is the management of a subarachnoid haemorrhage

A
  • specialist neurological unit
  • Surgical intervention may treat aneurysms
  • Nimodopine
  • LP/ insertion of a shunt to treat hydrocephalus
  • Anti-epileptics if seizing
21
Q

What is the aim of surgical intervention for aneurysms

A
  • repair the vessel and prevent re-bleeding
  • coiling, which involves inserting a catheter into the arterial system (taking an “endovascular approach”), placing platinum coils into the aneurysm and sealing it off from the artery
  • clipping, which involves cranial surgery and putting a clip on the aneurysm to seal it.
22
Q

What is nimodopine

A

calcium channel blocker that is used to prevent vasospasm. Vasospasm is a common complication that can result in brain ischaemia following a subarachnoid haemorrhage.

Neurology (9 decks)

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