Intracranial haemorrhage Flashcards
Extradural haemorrhage : Definition
Definition : Bleeding between the skull and dura matter
Rupture of the middle meningeal artery in the temporoparietal region
Cause : Head injury associated with temporal bone fractures
Extradural haemorrhage : Clinical features
- Head injury
- Headache
- Lucid interval - Period of improved neurological sx and consciousness - followed by rapid decline due to ongoing haematoma
Subdural haemorrhage : Definition
Subdural haemorrhage occurs between the dura mater and arachnoid mater
caused by a rupture of the bridging veins in the outermost meningeal layer
Subdural haemorrhage : Clinical features
Clinical features - dependant on type
Acute : < 48 hours following high impact injury
Rapid neurological deterioration
* Mass effect : midline shift, herniation, increased IC pressure
* N+V, Seizures, reduced consciousness
Subacute - days to weeks post injury
Chronic : Develops weeks to months
* Cause : Rupture of bridging veins within the subdural space causing slow bleeding
* RF : Alcoholic or Elderly have brain atrophy which increases risk of rupture
* Progressive hx of : Confusion, memory loss
Subarachnoid haemorrhage : Definition
Subarachnoid haemorrhage involves bleeding in the subarachnoid space, where the cerebrospinal fluid is located, between the pia mater and the arachnoid membrane.
Caused by : ruptured cerebral aneurysm.
Subarachnoid haemorrhage : Clinical features
1 . Sudden onset ‘Thunder clap’ headache
* Occipital headache peaking intensity 1-5 minutes
2 . N+V
3 . Meningism : Photophobia, Neckstiffness
Subarachnoid haemorrhage : Investigation
1 . CT head < 6 hours
* If > 6 hours,
* Lumbar puncture at minimum 12 hours after symptoms onset to allow development of xanthochromia ( RBC breakdown)
2 . If Confirmed; CT IC Angiogram
* Identify vascular lesion
Subarachnoid haemorrhage : Management
- Oral Nifedipine : prevent vasospasm
- Refer to neurosurgery
