Intracranial Haemorrhage Flashcards
what are the types of spontaneous intracranial haemorrhage
Subarachnoid Haemorrhage
Intracerebral Haemorrhage
Intraventricular Haemorrhage
what is a SAH
bleeding into the subarachnoid space
fatal if diagnosis missed
what can cause a SAH
- berry aneurysm (most commonly)
- AVM
- no underling cause found
what is a berry aneurysm
saccular aneurysm occurring at the bifurcations of the arteries
Sx of SAH
Sudden onset severe headache Collapse Vomiting Neck pain Photophobia
Signs of SAH
Neck stiffness
Photophobia
Decreased conscious level
Focal neurological deficit (dysphasia, hemiparesis, IIIrd n. palsy)
Fundoscopy - retinal or vitreous haemorrhage
what Sx in the eye would mean a patient should urgently be investigated for SAH
Painful oculomotor nerve palsy - painful eye and dilated pupil
why might a CT scan not be useful in certain time frames
may be negative if >3days post attack
what patients are safe to have a LP
Safe in alert patient with no focal neurological deficit and no papilloedema, or after normal CT scan
what is CSF suggestive of SAH
bloodstained or xanthochromic (yellowish) CSF
6-48hr
what do you need to be careful with CSF samples
‘traumatic tap’
blood in the CSF from the invasive LP technique
what is the gold standard test for SAH
cerebral angiography
what are complications of SAH
Re-bleeding Delayed ischaemic deficit Hydrocephalus - increased pressure due to accumulation of CSF Hyponatraemia Seizures
what are the forms of treatment to prevent re-bleeding
1st line - Endovascular techniques
2nd line - Surgical clipping
what is delayed ischaemic neurological deficit (DIND)
brain becomes ischaemic as the blood vessels go into spasm
altered/decreasing conscious level
focal deficit