Intracranial haemorrhage

Question 1

What is the most common underlying cause of a subarachnoid haemorrhage?

Answer 1

Berry aneurysm in the circle of willis

Question 2

A patients presents to a & e with a sudden onset headache which she says is “the worst pain ever” She is also vomiting and is drowsy.

Answer 2

Subarachnoid haemorrhage

Question 3

Answer 3

Subarachnoid haemorrhage

Question 4

What is the gold standard investigation to do in a subarachnoid haemmorhage?

Answer 4

Cerebral angiography

Question 5

What might you see on the fundoscopy of a patient with a subarachnoid haemmorhage?

Answer 5

Papillodema due to raised ICP

Question 6

What will a LP show in subarachnoid haemorrhage?

Answer 6

Frank blood that fails to clear

Question 7

What is the treatment for a patient who has a had a subarachnoid haemmorhage to prevent re bleeding?

Answer 7

Endovascular interventional radiology

Surgical clipping

Question 8

What drug is used in subarachnodi haemorrhage that is thought to reduce early morbidity caused by ischaemia?

Answer 8

Nimodipine - calcium channel blocker

Question 9

What can happen is you do an LP on a patient with hydrocephalus?

Answer 9

Coning (Brain stem become sucked into spinal cord) which can be fatal due to depression of cardiorespiratory centres.

Question 11

What is an intracerebral haemorrhage?

Answer 11

Bleeding into the brain parenchyma

Question 12

What are most intracerebral haemorrhages due to?

Answer 12

Hypertension

Question 13

What do you call microaneurysms caused by hypertension?

Answer 13

Charcot Bouchard aneurysms

Question 14

Where is the most common site for charcot bouchard aneurysms to form?

Answer 14

Vessels going to the basal ganglia

Question 15

A patient presents to a & e which right sided facial weakness. They also have a headacke and seem drowsy. What investigations should you perform first?

Answer 15

CT scan

Question 16

A patient presents to a & e which right sided facial weakness. They also have a headacke and seem drowsy. You suspect that an underlying vascular problem is causing this. You do a CT scan, what other investigation would you want to do?

Answer 16

Angiography to look for underlying vascular anomaly

Question 17

A patient presents to a & e which right sided facial weakness. They also have a headacke and seem drowsy. This is their CT scan. What is the diagnosis?

Answer 17

Intracerebral haemorrhage, causing a stroke

Question 18

What is the treatment of an intracerebral haemmorhage?

Answer 18

Surgical evacuation of the haemoatoma +/- treatment of any underlying abnormality

Question 20

How do you get an intraventricular haemorrhage?

Answer 20

When there is a rupture of a subarachnoid or intracerebra bleed into a ventricle