Intracranial Haemorrhage Flashcards
What are some examples of spontaneous intracranial haemorrhage?
Subarachnoid haemorrhage
Intracerebral haemorrhage
Intraventricular haemorrhage
What is the usual underlying cause of subarachnoid haemorrhage?
Berry aneurysm
Sometimes AVM
Can subarachnoid haemorrhage be fatal?
Yes, even with treatment 46% 30 day mortality
What is the presentation of SAH?
Sudden onset severe headache Collapse Vomiting Neck pain Photophobia
What is on the DDx for sudden onset headache?
SAH
Migraine
Benign coital cephalgia
What are the signs of SAH?
Neck stiffness
Photophobia
Decreased conscious level
Focal neurological deficit (dysphasia, hemiparesis, IIIrd n. palsy)
Fundoscopy - retinal or vitreous haemorrhage
Describe CT brain imaging in SAH
May be -ve if >3days post ictus
-ve in 15% of patients who have bled
When is LP safe in suspected SAH?
Safe in alert patient with no focal neurological deficit and no papilloedema, or after normal CT scan
What will be found on LP in suspected SAH?
Bloodstained or xanthochromic CSF (6-48hr)
Differentiate from traumatic tap
Describe cerebral angiography in SAH
Seldinger technique via femoral artery Digital Subtraction 4 vessel angiography with multiple views Gold standard Magnetic resonance and CT techniques increasingly used
When may cerebral angiography miss an SAH?
Due to vasospasm
What are some complications of SAH?
Re-bleeding Delayed ischaemic deficit Hydrocephalus Hyponatraemia Seizures
Is rebleeding important in SAH?
Yes
Often fatal
20% risk in first 14 days, 50% in 6 months
Describe delayed ischaemia in SAH
Can cause delayed ischaemic neurological deficit (DIND)
Occurs in days 3-12
Altered conscious level or focal deficit
Can cause vasospasm
How is delayed ischaemia treated post SAH?
Nimodipine
High fluid intake- ‘triple H therapy’
