Intracranial Haemorrhage Flashcards
How would an old subdural haemorrhage show on CT?
Hypodense crescent shaped lesion
How would a new subdural haemorrhage show on CT?
Hyperdense crescent shaped lesion
Where is a subdural haemorrhage?
Between the dura and arachnoid mater
What are the risk factors for subdural haemorrhage?
Historic head trauma
Anticoagulant use
Alcoholism
Old age
What kind of patient does a subdural haemorrhage tend to occur in?
Older patient > 65
What are the symptoms of a subdural haemorrhage?
Gradually increasing headache and confusion
Where is an extra dural haemorrhage?
Between the skull and the dura mater
What is the commonest cause of extradural haemorrhage?
Trauma to the pterion which tears the middle meningeal artery
What is the pterion?
where the frontal, parietal, sphenoidal and temporal bones meet
How does an extradural haemorrhage present?
Severe headache
Contralateral hemiplegia
Rapid deterioration in GCS following a lucid period
How is an extradural haemorrhage seen on CT?
Lemon shaped haematoma
Shift of the ventricles
Where is a subarachnoid haemorrhage?
Between the arachnoid and pia mater
What is the presentation of a subarachnoid haemorrhage?
Severe sudden onset of headache - worst headache of their life
Often in the occipital region
What are subarachnoid haemorrhages caused by?
Trauma
Spontaneous haemorrhage - most commonly due to the rupture of a berry aneurysm
What are the investigations used to diagnose SAH?
Non-contrast CT brain
Lumbar puncture
What would be seen on CT in a SAH?
A white area in the centre of the brain, expanding bilaterally
What would be seen on lumbar puncture in a SAH?
Blood in the CSF or xanthacromia
What is the preferred surgical intervention for SAH?
Endovascular coiling
What other surgical intervention can be performed for SAH?
Surgical clipping
What condition is associated with subarachnoid haemorrhage?
Polycystic kidney disease (patients with PCKD can develop berry aneurysms)
When would a lumbar puncture be performed to diagnose SAH?
If a CT head is inconclusive
When should a lumbar puncture be performed to diagnose SAH if a CT is inconclusive?
12 hours after SAH (+onwards)
What is the criteria for a CT in one hour after a head injury?
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
What is the criteria for a CT in one hour after head injury in children?
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
What is the immediate treatment of a SAH?
IV nimodipine or IV mannitol
Immediate neurosurgical referral
What is the management of chronic subdural haemorrhage?
Surgical decompression with burr holes (if patient is confused)
