Intracranial haemorrhage

Question 1

How does SAH present?

Answer 1

Sudden onset severe headache 
Collapse
Vomiting 
Neck pain
Photophobia

Question 2

What are the differential diagnoses for sudden onset headache?

Answer 2

SAH
Migraine
Benign coital cephalgia (sex)

Question 3

What investigations should be used to investigate SAH?

Answer 3

CT scan
LP
Cerebral angiography

Question 4

What are the potential complications of SAH?

Answer 4

Re-bleeding
Delayed ischaemic deficit 
Hydrocephalus 
Hyponatraemia
Seizures

Question 5

How might hydrocephalus present post SAH?

Answer 5

Increasing headache or transient altered conscious level

Question 6

What are 50% of intracerebral haemorrhages secondary to?

Answer 6

Hypertension

Question 7

What aneurysms arise on small perforating arteries in hypertensive ICH?

Answer 7

Charcot-Bouchard

Question 8

How does ICH present?

Answer 8

Headache
Focal neurological defect
Decreased conscious level (if big enough to cause raised ICP)

Question 9

How should ICH be investigated?

Answer 9

CT scan

Angiography (if suspected underlying vascular anomaly)

Question 10

How is ICH treated?

Answer 10

Surgical evacuation of haematoma +/- treatment of underlying abnormality