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Neurology - professional - batt > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

What is the presentation of an SAH?

A

sudden onset severe HA; collapse; vomiting; neck pain and photophobia

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2
Q

What do the N&V; neck pain and photophobia signify?

A

chemical meningitis due to blood in the subarachnoid space

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3
Q

What is the differential dignosis of sudden onset HA?

A

SAH; migraine; benign coital cephalgia

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4
Q

What is benign coital cephalgia?

A

HA onset after orgasm

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5
Q

How is benign coital cephalgia diagnosed?

A

diagnosis of exclusion

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6
Q

Why is benign coital cephalgia a diagnosis of exclusion?

A

SAH can also present after orgasm

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7
Q

What is the most common cranial nerve to be involved in SAH?

A

CNIII

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8
Q

What may be seen on fundoscopy in SAH?

A

retinal or vitreous haemorrhage

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9
Q

What imaging is used for SAH?

A

CT

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10
Q

How many patients have a negative CT with SAH?

A

15%

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11
Q

What ix should be done in a patient with suspected SAH with negative CT?

A

LP

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12
Q

When is an LP safe?

A

in alert patients with no focal neuro deficit and no signs of increased ICP or after normal CT scan

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13
Q

How long hsould you wait before doing an LP with SAH?

A

6-48hours

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14
Q

What would you expect to see with an LP in SAH?

A

xanthochromic CSF

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15
Q

What is xanthochromic CSF?

A

yellow CSF due to the breakdown products of blood

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16
Q

What artery is used for cerebral angiography?

A

femoral

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17
Q

Why may cerebral angiography miss an aneurysm?

A

vasospasm

18
Q

What are the complications of SAH?

A

re-bleeding; delayed ischaemic deficit; hydrocephalus; hyponatraemia; seizures

19
Q

How is rebleeding stopped?

A

endovascular techniques putting coils into the aneurysm

20
Q

When is delayed ischaemic neuro deficit seen?

A

days 3-12

21
Q

What causes delayed ischamia?

A

vasospasm

22
Q

what medication is given to try and prevent vasospasm?

A

nimodipine

23
Q

What therapy is give nafter SAH to prevent delayed ischaemia?

A

triple H therapy- hypertension; hypervolaemia and haemodilution

24
Q

What are the signs of delayed ischaemia?

A

altered consicous level or focal deficit

25
Q

What are the signs of hydrocephalus after SAH?

A

increasing HA or altered consicous level

26
Q

What is the treatment for hydrocephalus?

A

CSF drainage- LP; EVD; shunt

27
Q

What causes hyonatramia with SAH?

A

SIADH or cerebral salt wasting

28
Q

What is the treatment for hyponatraemia with SAH?

A

supplement sodium intake- do not fluid restrict; fludrocortisone

29
Q

What causes SIADH with SAH?

A

hypothalamic ischaemia

30
Q

What causes cerbral salt wasting with SAH?

A

naturietic hormone released pathologically

31
Q

What is an intracerebral haemorrhage?

A

bleeding into the brain parenchyma

32
Q

What is the most common cause of intracerebral haemorrhage?

A

hypertension

33
Q

What are the other causes of intracerbeal haemorrhage?

A

aneurysm or AVM

34
Q

What are Charcot-Bouchard microaneurysms?

A

arise from small perforating arteries

35
Q

What is the presentation of intracerebral haemorrhage?

A

HA- not as severe or as sudden as in SAH; focal neuro deficit; decreased conscious level

36
Q

What are hte investigations for intracerebal haemorrhage?

A

CT scan; angiography- if think vascular anomaly

37
Q

What is the treatment for ICH?

A

surgical evacuation of haematoma +/- tx of underlying abnormality- if big and causing life-threatening ICP

38
Q

What is an intraventricular haemorrhage?

A

rupture of a subarachnoid of intracerebral bleed into a ventricle

39
Q

Where do AVMs usually occu?

A

usually intraparenchymal

40
Q

What is the treatment fo AVMs?

A

surgery; endovascular embolisation; sterotactic radiotherapy

Neurology - professional - batt (40 decks)

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