Intracranial Bleeds Flashcards
From skull to brain, what are the layers you would have to cut through in order?
Dura mater
Arachnoid mater
Subarachnoid space
Pia mater
A patient opens their eyes to pain, is making incomprehensible sounds and is able to localise pain, what GCS score are they?
9
Eye open to pain: 2
Incomprehensible sounds: 2
Localises pain: 5
On the GCS, what is the maximum score for each threshold?
Eyes: 4
Verbal: 5
Motor: 6
At what GCS score should you consider intubation?
8
Full explanation of eye, verbal and motor components of the GCS (what each score means in each domain)
Eyes: 4-Opens spontaneously 3-Opens to voice 2-Opens to pain 1-Unresponsive
Verbal: 5-Orientated 4-Confused but talking normally 3-Inappropriate words 2-Incomprehensible sounds 1- Unresponsive
Motor 6- obeys commands 5- Localises pain 4- flexes to withdraw from pain 3- abnormal flexion 2- abnormal extension 1- unresponsive
What shape is seen on a CT in a subdural haemorrhage?
Crescent
Between what two layers does a subdural haemorrhage occur?
Between dura and arachnoid
What two groups of patients do subdural haemorrhage occur more commonly in?
Alcoholics
Elderly
What artery typically ruptures in an extradural haemorrhage?
Middle meningeal artery
What shape is seen on a CT in an extradural haemorrhage?
Biconvex
A typical history of an extradural haemorrhage is a __ patient with traumatic head injury with an ongoing headache, who may have lost consciousness. They have a period of ___ before declining quickly within hours.
Young
Improved consciousness
What condition presents with a thunderclap headache
Subarachnoid haemorrhage
What is the initial management of intracranial bleeds? (7)
Immediate CT
Check FBC and coag
Admit to specialist stroke unit
Discuss with surgical team
Consider intubation and ICU if reduced consciousness
Correct any clotting abnormalities
Correct severe hypertension but AVOID hypotension
