intracranial haemorrhage Flashcards
what are the 3 main types of intracerebral haemorrhage
supratentorial, infratentorial, intraventricular
what is the most common cause of primary intracerebral haemorrhage
hypertension
name some causes of secondary intracerebral haemorrhage
AV malformations, aneurysms, dural venous thrombosis
how does malignant hypertension cause intracerebral haemorrhage
acute severe HTN, causing rupture of previously unaffected artery
focal symptoms of an intracerebral haemorrhage
paresis, dysphasia, numbness, seizure, visual symptoms, dyscoordination
global symptoms of an intracerebral haemorrhage
headache N+V, reduced GCS, pupils
what is the most common cause of a subarachnoid haemorrhage
berry aneurysm
thunderclap headache
subarachnoid haemorrhage
where is a thunderclap headache most commonly felt
occipital - like being hit on the back of the head
what is a subarachnoid haemorrhage
bleeding between the pia mater and the arachnoid membrane (subarachnoid space)
investigation for a subarachnoid haemorrhage
CT - irregular shaped bleed, hyper-attenuation in the subarachnoid space
what can you do if there’s a negative CT scan in a suspected subarachnoid haemorrhage and what is a positive result
lumbar puncture: presence of blood or xanthocromia
what is xanthocromia
yellowing of CSF due to haemolysis of an older subarachnoid bleed
medical management of a subarachnoid haemorrhage
nimodipine - prevent delayed cerebral ischaemia caused by vasospasm
management of subarachnoid haemorrhage caused by aneurysm
endovascular coiling
what can be used to detect aneurysms in the brain
CT angiography
what usually causes a subdural haematoma
trauma causing damage to one of the bridging veins
what is a subdural haematoma
collection of blood between the dura mater and the arachnoid mater
who are the 2 groups of people who typically present with a subdural haematoma
patients following significant head trauma
elderly patients over 65
why are older patients more at risk of a subdural haematoma
age related brain atrophy increases the tension on bridging veins making them more prone to rupture
name some more risk factors for a chronic subdural haematoma
anticoagulant and antiplatelet therapy
alcohol related brain atrophy
bleeding disorders
chronic kidney disease due to platelet dysfunction
clinical presentation of subdural haematoma
headache, N+V, confusion, behavioural change
investigation for subdural haematoma and positive sign
head CT
crescent of blood around the brain tissue + midline shift
what indicates the need for surgical management of a subdural haematoma
significant midline shift
cerebral oedema
surgical management of an acute subdural haematoma
craniotomy
surgical management of a chronic subdural haematoma
burr holes
patient who is taking dabigatran (DOAC) has a subdural haematoma - what can you prescribe
idarucizumab
what is an extradural haematoma
collection of blood between the dura mater and the inner surface of the skull
what typically causes an extradural haemorrhage
fracture of temporal or parietal bone due to trauma
most common vessel damaged in an extradural haematoma
middle meningeal artery
classic clinical course seen in an extradural haematoma
brief LOC following initial injury
period of apparent recovery (the lucid interval)
subsequent deterioration with worsening symptoms and signs
clinical signs of extradural haematoma
external injuries
Cushing’s triad of raised ICP: bradycardia, hypertension and irregular breathing
6th nerve palsy
CSF otorrhoea or rhinorrhoea
unequal pupils
investigation for extradural haemorrhage and positive finding
non-contrast CT head
biconvex (lens shaped) hyperdense extra-axial collection
