Intracranial Haemorrhage

Question 1

How would an old subdural haemorrhage show on CT?

Answer 1

Hypodense crescent shaped lesion

Question 2

How would a new subdural haemorrhage show on CT?

Answer 2

Hyperdense crescent shaped lesion

Question 3

Where is a subdural haemorrhage?

Answer 3

Between the dura and arachnoid mater

Question 4

What are the risk factors for subdural haemorrhage?

Answer 4

Historic head trauma
Anticoagulant use
Alcoholism
Old age

Question 5

What kind of patient does a subdural haemorrhage tend to occur in?

Answer 5

Older patient > 65

Question 6

What are the symptoms of a subdural haemorrhage?

Answer 6

Gradually increasing headache and confusion

Question 7

Where is an extra dural haemorrhage?

Answer 7

Between the skull and the dura mater

Question 8

What is the commonest cause of extradural haemorrhage?

Answer 8

Trauma to the pterion which tears the middle meningeal artery

Question 9

What is the pterion?

Answer 9

where the frontal, parietal, sphenoidal and temporal bones meet

Question 10

How does an extradural haemorrhage present?

Answer 10

Severe headache
Contralateral hemiplegia
Rapid deterioration in GCS following a lucid period

Question 11

How is an extradural haemorrhage seen on CT?

Answer 11

Lemon shaped haematoma
Shift of the ventricles

Question 12

Where is a subarachnoid haemorrhage?

Answer 12

Between the arachnoid and pia mater

Question 13

What is the presentation of a subarachnoid haemorrhage?

Answer 13

Severe sudden onset of headache - worst headache of their life
Often in the occipital region

Question 14

What are subarachnoid haemorrhages caused by?

Answer 14

Trauma
Spontaneous haemorrhage - most commonly due to the rupture of a berry aneurysm

Question 15

What are the investigations used to diagnose SAH?

Answer 15

Non-contrast CT brain
Lumbar puncture

Question 16

What would be seen on CT in a SAH?

Answer 16

A white area in the centre of the brain, expanding bilaterally

Question 17

What would be seen on lumbar puncture in a SAH?

Answer 17

Blood in the CSF or xanthacromia

Question 18

What is the preferred surgical intervention for SAH?

Answer 18

Endovascular coiling

Question 19

What other surgical intervention can be performed for SAH?

Answer 19

Surgical clipping

Question 20

What condition is associated with subarachnoid haemorrhage?

Answer 20

Polycystic kidney disease (patients with PCKD can develop berry aneurysms)

Question 21

When would a lumbar puncture be performed to diagnose SAH?

Answer 21

If a CT head is inconclusive

Question 22

When should a lumbar puncture be performed to diagnose SAH if a CT is inconclusive?

Answer 22

12 hours after SAH (+onwards)

Question 23

What is the criteria for a CT in one hour after a head injury?

Answer 23

More than one episode of vomiting
Clinical evidence of a skull fracture
More than 30 minutes of retrograde amnesia
GCS <13
GCS < 15 after 2 hours
Any sign of basal skull fracture - panda eyes, haemotympanum, CSF leakage from ear or nose
Focal neurological deficit
Post-trauma seizure

Question 24

What is the criteria for a CT in one hour after head injury in children?

Answer 24

Suspicion of non-accidental injury
Post-traumatic seizure
GCS < 14 or GCS < 15 if infant
Evidence of skull fracture
Tense fontanelle
Signs of a basal skull fracture
Focal neurological deficits

Question 25

What is the immediate treatment of a SAH?

Answer 25

IV nimodipine or IV mannitol
Immediate neurosurgical referral