Intracranial Haemorrhage

Question 1

A patient presents with a sudden onset severe headache and neck pain. She has also been vomiting, complains of photophobia and had a brief collapse prior to admission. What is the diagnosis?

Answer 1

Subarachnoid Haemorrhage

Question 2

What is benign coital cephalgia?

Answer 2

Sudden onset headache before orgasm

Question 3

When may a CT scan be negative in assessing SAH?

Answer 3

If done > 3 days post haemorrhage

Question 4

What is the gold standard investigation to check for SAH/Berry aneurysm?

Answer 4

Cerebral Angiography

- may miss an aneurysm due to vessel vasospasm

Question 5

What are some complications of a SAH?

Answer 5

• Re-bleeding
• Delayed ischaemic deficit
• Hydrocephalus
• Hyponatraemia
• Seizures

Question 6

What is the ‘Triple H therapy’ and why is it used to manage delayed ischaemia in the brain?

Answer 6

• Induced hypertension, hypervolaemia & haemodilution

- Prevents cerebral vasospasm

Question 7

Which syndrome causes hyponatraemia in patients following a cerebral haemorrhage?

Answer 7

Syndrome of Inappropriate ADH secretion (SIADH)
(‘cerebral salt wasting’)
- DO NOT fluid restrict

Question 8

A patient presents with a new onset headache, focal neurological deficit and decreasing consciousness. What is the likely diagnosis?

Answer 8

An Intracerebral haemorrhage (bleeding into the brain parenchyma)

Question 9

When is the prognosis in ICH:

1. Good
2. Bad

Answer 9

1. If small superficial clot and good neurological status

2. If large basal ganglia/thalamic clot with major focal deficit/deep coma

Question 10

When does an intraventricular haemorrhage occur?

Answer 10

Occurs with rupture of a subarachnoid or intracerebral bleed into a ventricle

Question 11

What are ateriovenous malformations? (AVMs)

Answer 11

Clumps of abnormal blood vessels within the brain without a proper capillary bed in between arteries and veins