Intracranial haemorrhage Flashcards
Focal neurological deficits associated with SAH?
Dysphasia
Hemiparesis
IIIrd nerve palsy
When is lumbar puncture safe?
If no neurological deficit and no papillodema
Do after normal CT scan
GOLD STANDARD INVESTIGATION for SAH?
Digital subtraction angiography
What is DIND? and when does it occur?
Delayed ischemic neurological deficit
Occurs 3-12 days after SAH
Treatment for delyaed ischemic neurological deficit? (DIND)
- hypertension
- hypervolemia
- haemodilution
“triple H therapy” –> aims to increase cerebral perfusion after ischemia
-Nimodopine- reduces vasospasm so reduces chances of ischemia
Headache following SAH gets worse, not better, what should you consider?
Hydrocephalus
Someone with SAH develops altered consciousness/focal deficit 3-12 days after, what should you think about?
DIND (delayed ischemic neurological deficit)
Treatment for hyponatremia (SIADH/ “cerebral salt wasting”) in SAH
- do not fluid restrict
- supplement sodium intake
- fludrocortisone
Types of intracerebral haemorrhage that can result from hypertension?
Charcot-bouchard microaneurysms
Basal ganglia haematoma
What are charcot-bouchard microaneurysms?
Charcot bouchard aneursyms are minute aneurysms that develop as a result of chronic hypertension and appear most commonly in the basal ganglia
If patient has decreased conscious level, what investigation must you do urgently?
CT !!
What is steal syndrome?
Steal syndrome: basically the blood can flow backwards due to subclavian stenosis/occlusion. This means you can get upper limb ischemia and sometimes neurological symtpoms as well. You can get a version of this caused by fistulas used in dialysis
Treatment of AVMs
Surgery
Endovascular embolisation
Stereotactic radiotherapy
Conservative
Weigh risks against benefit
