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’
What is hydrocephalus?
Increased intracranial CSF pressure
What are the symptoms of hydrocephalus?
Increasing headache or altered conscious level
Often transient
What is the treatment for hydrocephalus?
CSF drainage- LP, EVD, Shunt
How should hyponatraemia be treated?
Do not fluid restrict
Supplement sodium intak
Fludrocortisone
What are some causes of intracerebral haemorrhage?
50% 2’ to HT
30% due to aneurysm or AVM
What are some causes of hypertensive ICH?
‘Charcot- Bouchard’ microaneurysms arising on small perforating arteries
Basal ganglia haematoma
What is the presentation of ICH?
Headache
Focal neurological deficit
Decreased conscious level
What Ix are required in ICH?
CT scan- urgent if decreased conscious level
Angiography if suspicion of vascular anomaly
What is the treatment of ICH?
Surgical evaluation of haematoma +- treatment of underlying abnormality
Non-surgical management
When is the prognosis of ICH good?
If small superficial clot and good neurological status
When is the prognosis of ICH poor?
If large basal ganglia or thalamic clot with major focal deficit or deep coma
When does intraventricular haemorrhage occur?
Rupture of a subarachnoid or intracerebral bleed into a ventricle
Describe AVMs
Arterio-venous shunts
Usually intraparenchymal
Congenital
What can AVMs cause?
Seizures
Haemorrhage- ICH, SAH, subdural
Headache
Steal syndrome
How are AVMs treated?
Surgery
Endovascular embolization
Stereotactic radiotherapy
Conservaitve
