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N - C > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

What are the causes of Intracranial haemorrhage?

A
  1. Trauma
  2. Hypertension
  3. Vascular Malformations
    - Cerebral aneurysm
    - Arteriovenous malformation
    - Cavernous haemangioma
  4. Infection
  5. Intracranial tumours
  6. Bleeding disorders
  7. Drugs
  8. Iatrogenic
  9. Others
    - Amyloidangiiopathy
    - Granulomas
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2
Q

What are the clinical features of intracerebral haemorrhage?

A

Increased intracranial pressure

Focal neurological defict

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3
Q

What is the clinical features of increased intracranial pressure?

A

Headache
Nausea and vomiting
Blurred vision
Decreased level of consciousness

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4
Q

What is the clinical features of focal neurological deficit?

A
  • Motor hemiparesis/ plegia
  • Sensory deficit
  • Cranial nerve deficit
  • Balance and co-ordination
  • Speech and language
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5
Q

How should you manage ICH?

A

Initial evaluation

Measures to prevent further rise in ICP

Treatment of raised ICP

Medical vs. surgical

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6
Q

What should be involved with you initial evaluation of ICH?

A

Evaluation and stabilise vital signs and protect airway

Biochemistry and haematological tests

CT brain

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7
Q

What are the measures to prevent further rise in ICP?

A

Control hypertension

Treat seizures

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8
Q

What is the location of an extradural haemorrhage?

Is it more likely to be traumatic or spontaneous?

A

Between bone and dura

Traumatic

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9
Q

What is the location of a subdural haemorrhage?

Is it more likely to be traumatic or spontaneous?

A

Between dura and arachnoid

Traumatic

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10
Q

What is the location of a subarachnoid haemorrhage?

Is it more likely to be traumatic or spontaneous?

A

Bellow the arachnoid

Both

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11
Q

What is the location of an intracerebral haemorrhage?

Is it more likely to be traumatic or spontaneous?

A

Inside the brain tissue

Spontaneous

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12
Q

What is the location of an intraventricular haemorrhage?

Is it more likely to be traumatic or spontaneous?

A

Inside the ventricles

Spontaneous

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13
Q

What is the mean age of presentation of SAH from intracranial aneurysm?

A

50 years

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14
Q

Sub arachnoid haemorrhage is more common in which sex?

A

Female

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15
Q

In younger people SAH is associated with what?

A

Polycystic Kidney Disease

Coarctation of the aorta

Marfan’s syndrome

Ehler-Danlos Syndrome

Familial

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16
Q

What are the clinical features of an aneurysmal SAH?

A
  1. Sudden severe headache
  2. Nausea and vomiting
  3. Photophobia
  4. Meningism- Neck pain
  5. Decreased level of consciousness
  6. Focal neurological deficit
  7. Seizures
17
Q

What are the investigations for aneurysmal SAH?

A

CT

LP if CT is negative

Cerebral Angiography

Biochemistry
-U and Es

Haematology
-HB, WBC and clotting

18
Q

How do you distinguish between traumatic and spontaneous SAH?

A

Clinical history - Trauma OR sudden headache

Radiological features- Blood in the convexities VS blood inside basal cisterns/ deep sulci

19
Q

What is the medical management of aneurysmal SAH?

A

-Bed rest
-Adequate analgesics
-Anti-emetics
-Nimodipine
-Stool softeners
-Ted stockings
-Fluid administration
(Triple H - Hypertension, Hypervolemia, Hyperdilution)

20
Q

What is the definitive treatment of aneurysmal SAH?

A

Endovascular embolisation

Surgical clipping

21
Q

Give an intro to arteriovenous malformation

A

Congenital

Arteries flow straight into veins (no transition from capillaries)

Clinical symptoms in the second and third decades of life

Male = female

22
Q

What are the clinical features of arteriovenous malformation?

A

Intracranial haemorrhage

Seizures

Focal neurological deficit

Haedache

Impaired higher cortical function

Bruit

23
Q

What investigations do you perform in arteriovenous malformation?

A

CT
MR
Angiography

24
Q

What is the treatment for arteriovenous malformation?

A

Endovascular embolisation

Stereotactic radiosurgery

Surgical excision

25
Q

What other vascular malformations are there?

A

Carvenous angioma

  • May be clinically silent
  • Seizures
  • Haemorrhage

A-V dural fistula

26
Q

What is the typical presentation of intracerebral haemorrhage?

A

Hypertension

  • Basal ganglia bleed
  • Thalamic
27
Q

What is the atypical presentation of intracerebral haemorrhage?

A

Lobar

28
Q

What drugs/ medications may cause ICH?

A

Sympathomimetics

  • Amphetamines
  • Cocaine

Anticoagulants

29
Q

what are the risk factors for drugs/medications causing ICH?

A
  • Advancing age
  • Hypertension
  • Preceding cerebral infarct
  • Head injury

N - C (35 decks)

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