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neuro > INTRACRANIAL BLEEDS- extra/subdural haematoma + SAH > Flashcards

INTRACRANIAL BLEEDS- extra/subdural haematoma + SAH Flashcards

1
Q

Risk factors- intracranial bleeds?

A

Risk factors
-Head injury
-Hypertension
-Aneurysms
-Ischaemic stroke can progress to haemorrhage
-Brain tumours
-Anticoagulants e.g. warfarin

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2
Q

Presentation- intracranial bleeds?

A

-Sudden onset headache

-Seizures, weakness, vomiting, reduced consciousness, other sudden onset neurological symptoms

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3
Q

what is used to assess the level of consciousness and what is it marked out of?

A

Glasgow coma scale

3-15

Eye opening response- out of 4
Verbal response- out of 5
Motor response- out of 6

15= best response
8 or less= comatose
3= totally unresponsive

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4
Q

Name the criteria for the eye opening response- GCC

A

4- spontaneously
3- to speech
2- to pain
1- unresponsive

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5
Q

Name the criteria for the verbal response- GCC

A

5- can orientate time, place + person
4- confused
3- inappropriate words
2- incoherent sounds
1- unresponsive

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6
Q

Name the criteria for the motor response- GCC

A

6- can follow commands
5- moves to localised pain
4- flex to withdraw from pain
3- abnormal flexion
2- abnormal extension
1- unresponsive

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7
Q

what should be done if GCS is 8/15 or below?

A

airway should be secured

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8
Q

what type of intracranial bleeds are spontaneous?

A

-intracerebral
-SAH
-haemorrhagic infarct

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9
Q

what type of intracranial bleeds are traumatic?

A

-subdural
-extradural
-contusion (surface bruising)
-intracerebral
-SAH

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10
Q

what is an extradural haematoma?

A

collection of blood between the dura and the skull

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11
Q

where does bleeding occur in extradural haematoma?

A

between the dura mater and the skull

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12
Q

what artery is ruptures in extradural haematoma?

A

middle meningeal artery

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13
Q

what fracture is associated with extradural haematoma?

A

temporal bone fracture
- Middle meningeal artery is located in temporo parietal region
- Pterion is weakest part of skull (where all the parts of skull join)

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14
Q

typical patient presenting with extradural haeatoma?

A

young patient with head trauma

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15
Q

presentation- extradural haematoma?

A

-On going headache
-N+V
-Decreased consciousness
-Confusion
-Unilateral fixed pupils, RAPD
-Period of improved neurological symptoms and consciousness (lucid period) followed by a rapid decline over hours

-Rapid decline as the haematoma gets large enough to compress the intracranial contents

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16
Q

investigations- extra dural haematoma?

A

Urgent CT

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17
Q

what is seen on CT of extradural haematoma?

A

-lens shape/ bi convex/ lemon shaped mass

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18
Q

treatment extradural haematoma?

A

urgent decompression surgery

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19
Q

where is blood found in a subdural haematoma?

A

between the dura and arachnoid mater

20
Q

what vessel ruptures in subdural haematoma?

A

bridging veins (between dura mater and arachnoid mater)

21
Q

who is more likely to get a subdural haematoma?

A

People with brain atrophy
-older patients
-alcoholics

22
Q

are subdural haematomas unilateral or bilateral?

A

can be both
-more likely to be bilateral in children

23
Q

presentation- subdural haematoma?

A

Slower onset of symptoms than epidural haematoma
* Fluctuating confusion/ consciousness
* Headaches
* N+V
* Neuro deficits
* Personality changes
* Incontinence
* Confusion
* Gait changes/ Hemiparesis

24
Q

what can mass effect of subdural haematoma cause?

A

herniations

25
Q

how does subdural haematoma present macroscopically?

A

liquified blood/ yellow fluid

26
Q

investigations- subdural haematoma?

A

1st line= URGENT CT

27
Q

what is seen on CT- subdural haematoma?

A

Crescent/ Concave/ banana shape

-Not limited to coronal sutures

28
Q

difference between chronic and acute subdural haematoma on CT?

A

chronic- blood is hypodense

acute- blood is hyperdense

Blood is thicker when acute and so appears hyperdense

29
Q

treatment- subdural haematoma?

A

Conservative:
Watch and wait for 2 weeks (can clear spontaneously)
* Raised ICP= Mannitol
* Repeat CT in 6 months

Large + symptomatic= BURR HOLE/ CRANIOTOMY
-Repeat CT in 2-3 days

30
Q

what medication can be given for raised ICP in subdural haematoma?

A

Mannitol

31
Q

subarachnoid haemorrhage- what?

A

-arterial bleeding into the subarachnoid space

-can be either spontaneous or traumatic

-accounts for 5% of strokes

32
Q

causes of SAH?

A

-spontaneous or traumatic

ruptured berry aneurysm (PKD)= most common
AVM
Idiopathic

33
Q

SAH- presentation?

A

Buzz word= Sudden onset ‘Thunderclap’ headache

-10/10 severe, ‘Worst headache of life’, Occipital headache, ‘hit in back of the head’
-Neck stiffness
-N + V
loss of consciousness/ collapse/ confusion/ seizure
-Photophobia

34
Q

SAH- signs?

A

focal neurological deficit= CNIII palsy + RAPD
May see retinal/ vitreous haemorrhage on fundoscopy

35
Q

SAH- investigations?

A

acute= immediate CT (SAH until proven otherwise)

Gold standard= cerebral angiography
-once diagnosis confirmed cerebral angiography is used to locate the bleed

can do Lumbar puncture:
-blood in CSF
-from 6 to 48 hours Xanthochromia

36
Q

maangement for SAH?

A

Urgent referral to neurosurgery

-bed rest, analgesia, anti- emetic, IV fluids

37
Q

another name for intracerebral haemorrhage?

A

intraparanchymal haemorrhage

38
Q

what diseases are associated with SAH?

A

Disease Associations:
-Sickle cell anaemia
-CTD (Marfans, Ehlers Danlos)
-Neurofibromatosis
-ADPKD

39
Q

what is an intracerebral haemorrhage?

A

bleeding into parenchyma

40
Q

what sign is seen on CT for SAH?

A

star shaped

41
Q

most common place for intracerebral haemorrhage to occur?

A

basal ganglia

42
Q

most common cause of intracerebral haemorrhage?

A

hypertension

43
Q

how is intracerebral haemorrhage diagnoses?

A

CT

44
Q

treatment- intracerebral haemorrhage?

A

supportive measures (same as haemorrhagic stroke)

45
Q

croup and contra coup- what?

A

Coup
-truama causing brain to move and strikes part of the skull where trauma was

Contra-coup
-when brain hits off the other side of skull from where the trauma was

neuro (44 decks)

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