Intracranial Haemorrhage Flashcards
What are the 3 types of intracranial haemorrhage?
Subarachnoid Haemorrhage
Intracerebral Haemorrhage
Intraventricular Haemorrhage
What is subarachnoid haemorrhage?
Bleeding into the subarachnoid space
What is the usual cause of a subarachnoid haemorrhage?
berry aneurysm
Symptoms of subarachnoid haemorrhage?
Sudden onset severe headache Collapse Vomiting Neck pain Photophobia
Name the 3 main differentials of a sudden onset headache?
Subarachnoid Haemorrhage
Migraine
Benign coital cephalgia
Sigsn of subarachnoid haemorrhage?
Decreased conscious level
Focal neurological deficit (dysphasia, hemiparesis, IIIrd n. palsy)
SAH signs on fundoscopy?
retinal or vitreous haemorrhage
In SAH, when may CT scan be negative?
May be negative if >3days post ictus
Negative in 15% of patients who have bled
What will a lumbar puncture help differentiate SAH from?
from ‘traumatic tap’
What will CSF be like in SAH?
bloodstained or xanthochromic CSF
When may lumbar puncture not be safe?
focal symptoms
papilloedema
What technique is used in Cerebral Angiography?
Seldinger technique
Complications of SAH?
Re-bleeding Delayed ischaemic deficit Hydrocephalus Hyponatraemia Seizures
What is hydrocephalus?
Increased intracranial CSF pressure, often asymptomatic
What may symptoms of hydrocephalus be?
Increasing headache or altered conscious level
Treatment of hydrocephalus?
CSF drainage - LP, EVD, Shunt
Treatment of hyponatraemia/ SIADH?
Do not fluid restrict
supplement sodium intake
fludrocortisone
What is Intracerebral Haemorrhage?
Bleeding into brain parenchyma
50% of time due to hypertension, may also be due to aneurysm or arteriovenous malformation
In hypertensive ICH, what arises on small perforating arteries?
‘Charcot- Bouchard’ microaneurysms
Basal ganglia haematoma
Presentation of ICH?
Headache
Focal neurological deficit
Decreased conscious level
Investigations of ICH?
CT scan - urgent if decreased conscious level
Angiography if suspicion of underlying vascular anomaly
Treatment of ICH?
Surgical evacuation of haematoma +/-treatment of underlying abnormality
What is the name for rupture of a subarachnoid or intracerebral bleed into a ventricle?
intraventricular haemorrhage - any combination of subarachnoid, intracerebral and intraventricular haemorrhage can occur
What drugs can cause spontaneous intracranial haemorrhage?
warfarin, heparin
