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Neurology > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

What are the main subtypes of a spontaneous intracranial haemorrhage

A

Subarachnoid
Intracerebral
Intraventricular

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2
Q

What is a subarachnois haemorrhage

A

Bleeding into the subarachnoid space

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3
Q

What is the prognosis of a subarachnoid

A

Potentially fatal

45 percent 30 day mortality rate

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4
Q

What is the main underlying cause of a subarachnoid

A

Berry aneurysm
Arteriovenous malformation
idiopathic- no cause
trauma

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5
Q

How does SAH present?

A 
Sudden onset severe headache- 'thungerclap'
Collapse
Vomiting
Neck pain
Photophobia
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6
Q

What signs are present in SAH

A

Neck stiffness
Photophobia
Decrease consciousness
Focal neurological deficit- dysphasia, hemiparesis, third nerve palsy

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7
Q

What can be seen on fundoscopy of a SAH

A

retinal or vitreous haemorrhage

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8
Q

What does a third nerve palsy look like clinically

A

Eye position is down and out due to now unopposed lateral rectus and SO muscles
Lid pstosis - due to levator palperbrae superioris
Blown out pupil- as CN 3 innevates the sphinter pupillae muscles

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9
Q

What are the down sides to CT in imaging a SAH

A

can be negatice if more than 3 days post ictus

can be falsely negative in up to 15 percent of pts

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10
Q

When is a lumbar puncture safe?

A

in alert pts with no focal neuro deficit, no papilloaedaema or after normal CT

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11
Q

What will be the features of the CSF in someone who has had a SAH

A

bloodstained

xanthochromic

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12
Q

What is the seldinger technique

A

The Seldinger technique, also known as Seldinger wire technique, is a medical procedure to obtain safe access to blood vessels and other hollow organs

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13
Q

Where is the guidewire initially inserteted when performing cerebral angiography

A

femoral artery

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14
Q

What is the gold standard inverstigation for a SAH

A

cerebral angiography

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15
Q

Name some complications of a SAH

A 
re bleeding
delayed ischaemic deficit
hydrocephalus
hypnatraemia
seizures
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16
Q

What are the risks of re bleeding

A

often fatal
20 percent risk in first 14 days
50 percent risk in first 6 mths

17
Q

When does DIND usually occur

A

day 3-12

18
Q

what is vasospasm

A

Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction

19
Q

how can vasospasm be prevented

A

Nimodipine - calcium channel blocker

20
Q

What is the principle method of treatment for DIND due to vasospasm

A

High fluid intake ie Triple H therapy

  • hypertension
  • hypervolaemia
  • hemidilution
21
Q

What is hydrocephalusq

A

increase intracranial CSF

22
Q

How is hydrocephalus treated?

A

CSF drainage by

  • lumbar puncture
  • shunt
  • external ventricular drainage
23
Q

What is SIADH

A

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive release of antidiuretic hormone from the posterior pituitary gland or another source. The increase in blood volume (hypervolemia) often results in dilutional hyponatremia in which the plasma sodium levels are lowered and total body fluid is increased

24
Q

How is SIADH treat in the context of a SAH

A

do not fluid restrict

Supplement sodium Treat with fludrocortisone

25
Q

What is the risk of siezures post SAH

A

3 percent acutely

10 percent five year risk

26
Q

What is an intracerebral haemorrhage

A

Bleeding into the brain parenchyma

27
Q

What is the main cause of intracerebral haemorrhage

A

Hypertension - half of cases
Aneurysm
AVM

28
Q

What is a charcot bouchard aneurysm

A

aneurysms of the brain vasculature which occur in small blood vessels (less than 300 micrometre diameter
-common cause of ICH

29
Q

How can ICH present

A

headache
FND
decreased consciousness

30
Q

What investigations are used in ICH

A

CT scan urgently

Angiography is suspected vascular anomaly

31
Q

What is an intraventricular haemorrhage

A

A bleed into the ventricles due to a rupture of a subarachnoid or intracerebral bleed into the ventricle

32
Q

what is steal syndrome

A

a constellation of signs and symptoms that arise from retrograde (reversed) flow of blood in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery.

Neurology (36 decks)

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