Intracranial bleeds/haemorrhages

Question 1

Name 3 risk factors for an brain bleed

Answer 1

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

Question 2

1) What is the key presentation of an brain bleed?
2) Name 2 other ways they can present

Answer 2

1) Sudden onset headache
2) Seizures, weakness, vomiting, reduced consciousness, other sudden onset neurological symptoms

Question 3

What are the 4 types of brain bleeds?

Answer 3

• Extradural/epidural
• Subdural
• Subarachnoid
• Intracerebral

Question 4

Extradural/epidural haemorrhage (EDH)
1) What is an EDH?
2) What is the commonest cause of an EDH?
3) Name 1 thing that can cause this
4) How does it normally present?
5) How does a EDH classically present on a CT scan?

Answer 4

1) Collection of blood between the periosteal layer of the dura mater and the inner surface of the skull
2) Tear of the middle meningeal artery
3) Traumatic head injury i.e. sport accident, road traffic accident
4) Brief loss of consciousness, followed by regaining of normal consciousness level (the lucid interval), with subsequent deterioration of consciousness
5) Biconvex shape

Question 5

Subdural haemorrhage (SDH)
1) What is a SDH?
2) What is the typical history of a SDH?
3) Name 2 SDH risk factors
4) What is the main difference between a SDH and EDH?
5) How does SDH classically present on a CT scan?

Answer 5

1) Collection of venous blood accumulating in the potential space between the dura mater and arachnoid mater due to rupture of the bridging veins in the periosteal layer of the dura mater
2) Elderly patients following minor trauma, resulting in shearing forces that tear bridging veins between the cortex and dura mater
3) Older age (>65 years old), bleeding disorders or anticoagulant therapy, chronic alcohol use, recent trauma.
4) Slower onset of symptoms
5) Crescent shape

Question 6

Subarachnoid haemorrhage (SAH) (1)
1) What is a SAH?
2) What is the typical cause of an SAH?
3) Name another cause of a SAH
4) What is the typical history of a SAH
5) Name 2 other ways it can present
6) What is the first line investigation?
7) What is the the gold standard for detection, demonstration and localization of ruptured aneurysms?

Answer 6

1) Bleeding into the subarachnoid space
2) Ruptured cerebral aneurysm
3) Arteriovenous malformations, encephalitis, vasculitis, tumour
4) Sudden onset severe occipital headache - thunderclap headache
5) Neck stiffness, photophobia, vision changes, neurological symptoms such as speech changes, weakness, seizures and loss of consciousness
6) Head CT
7) Cerebral angiography

Question 7

Subarachnoid haemorrhage (SAH) (2)
1) Name 2 risk factors for SAH
2) Name a group of patients that are more likely to suffer a SAH

Answer 7

1) Hypertension, smoking, excessive alcohol consumption, cocaine use, family history, having sickle cell anaemia
2) Black patients, female patients, age 45-70

Question 8

Intracerebral haemorrhage
1) What is an intracerebral haemorrhage?
2) Intracerebral haemorrhage is considered a type of what condition?

Answer 8

1) Bleeding into brain tissue
2) Stroke

Question 9

Name 2 aspects of the management of brain bleeds

Answer 9

• Monitor FBC and clotting
• Admit to a specialist stroke unit
• Consider intubation, ventilation and ICU care if they have reduced consciousness
• Correct any clotting abnormality
• Correct severe hypertension but avoid hypotension
• Consider any surgical options

Question 10

At which GCS would you intubate the patient?

Answer 10

8