Intracranial Haemorrhage Flashcards
What is the presentation of an SAH?
sudden onset severe HA; collapse; vomiting; neck pain and photophobia
What do the N&V; neck pain and photophobia signify?
chemical meningitis due to blood in the subarachnoid space
What is the differential dignosis of sudden onset HA?
SAH; migraine; benign coital cephalgia
What is benign coital cephalgia?
HA onset after orgasm
How is benign coital cephalgia diagnosed?
diagnosis of exclusion
Why is benign coital cephalgia a diagnosis of exclusion?
SAH can also present after orgasm
What is the most common cranial nerve to be involved in SAH?
CNIII
What may be seen on fundoscopy in SAH?
retinal or vitreous haemorrhage
What imaging is used for SAH?
CT
How many patients have a negative CT with SAH?
15%
What ix should be done in a patient with suspected SAH with negative CT?
LP
When is an LP safe?
in alert patients with no focal neuro deficit and no signs of increased ICP or after normal CT scan
How long hsould you wait before doing an LP with SAH?
6-48hours
What would you expect to see with an LP in SAH?
xanthochromic CSF
What is xanthochromic CSF?
yellow CSF due to the breakdown products of blood
What artery is used for cerebral angiography?
femoral
Why may cerebral angiography miss an aneurysm?
vasospasm
What are the complications of SAH?
re-bleeding; delayed ischaemic deficit; hydrocephalus; hyponatraemia; seizures
How is rebleeding stopped?
endovascular techniques putting coils into the aneurysm
When is delayed ischaemic neuro deficit seen?
days 3-12
What causes delayed ischamia?
vasospasm
what medication is given to try and prevent vasospasm?
nimodipine
What therapy is give nafter SAH to prevent delayed ischaemia?
triple H therapy- hypertension; hypervolaemia and haemodilution
What are the signs of delayed ischaemia?
altered consicous level or focal deficit
What are the signs of hydrocephalus after SAH?
increasing HA or altered consicous level
What is the treatment for hydrocephalus?
CSF drainage- LP; EVD; shunt
What causes hyonatramia with SAH?
SIADH or cerebral salt wasting
What is the treatment for hyponatraemia with SAH?
supplement sodium intake- do not fluid restrict; fludrocortisone
What causes SIADH with SAH?
hypothalamic ischaemia
What causes cerbral salt wasting with SAH?
naturietic hormone released pathologically
What is an intracerebral haemorrhage?
bleeding into the brain parenchyma
What is the most common cause of intracerebral haemorrhage?
hypertension
What are the other causes of intracerbeal haemorrhage?
aneurysm or AVM
What are Charcot-Bouchard microaneurysms?
arise from small perforating arteries
What is the presentation of intracerebral haemorrhage?
HA- not as severe or as sudden as in SAH; focal neuro deficit; decreased conscious level
What are hte investigations for intracerebal haemorrhage?
CT scan; angiography- if think vascular anomaly
What is the treatment for ICH?
surgical evacuation of haematoma +/- tx of underlying abnormality- if big and causing life-threatening ICP
What is an intraventricular haemorrhage?
rupture of a subarachnoid of intracerebral bleed into a ventricle
Where do AVMs usually occu?
usually intraparenchymal
What is the treatment fo AVMs?
surgery; endovascular embolisation; sterotactic radiotherapy
