Intracranial Haemorrhage (1) Flashcards
Extradural Haemorrhage:
What is usually caused by?
How does it present?
What is seen on CT?
How is it managed?
➊ Trauma to the pterion, leading to rupture of MMA
➋ Lucid interval followed by acute severe headache and a rapid deterioration in GCS
N.B. Lucid interval occurs as the haematoma grows large enough to cause a large rise in ICP
➌ Bi-convex/Lens-shaped haematoma - limited to cranial sutures
➍ Neurosurgical intervention
Subdural Haemorrhage:
Who is it more common in?
How does it present?
What is seen on CT?
How is it managed?
➊ Elderly and Alcoholics
N.B. These pts have more cerebral atrophy, therefore making their bridging vessels more likely to tear and rupture
➋ Gradually increasing headache and confusion
➌ Crescent-shaped haematoma - not limited to cranial sutures
➍ Neurosurgical intervention if severe haemorrhage and symptomatic
Subarachnoid Haemorrhage (Stroke):
What is it usually caused by?
How does it present?
What are its differentials?
What’s the 1st line investigation to do?
→ What should be done if this is -ve?
How is it managed?
→ What is done for its complications?
➊ Rupture of a berry aneurysm in the circle of willis
➋ * Thunderclap headache - Sudden, severe occipital headache that typically comes on during strenuous activity
* Meningism - Neck stiffness, Photophobia
* N+V
* Visual changes
* Neurological symptoms - LOC, dysphasia, weakness, seizures
➌ * Meningitis
* Migraine
* Intracerebral haemorrhage
➍ CT head - Hyperattenuation in sub-arachnoid space that expands bilaterally
→ LP - Looking for Xanthochromia (yellowing of csf due to haemolysis)
N.B. LP should be done at least 12 hrs after onset of symptoms.
N.B. The initial LP may have blood due to trauma. To differentiate this from a true SAH is to do a repeat sample. A drop in the RBC count → trauma. No drop in RBC count → SAH.
➎ Neurosurgical intervention
→ ‣ Cerebral Ischaemia - Oral Nimodipine that prevents vasospasm, which can result in brain ischaemia
‣ Rebleeding - Endovascular coiling or surgical clipping to treat aneurysms
‣ Hydrocephalus - LP or shunt insertion
‣ Seizures - Antiepileptics
