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Neuro > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

What are the types of intracranial haemorrhage

A

Extradural
Subdural
Subarachnoid

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2
Q

What is extradural haemorrhage

A

Collection of blood between inner surface of skull and dura mater (endosteal layer)

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3
Q

What vessels are involved in EDH

A

middle meningeal artery (90%)

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4
Q

What is the mechanism of EDH

A

Trauma - pterion fracture

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5
Q

What age group is EDH common in

A

Young: <20yo 50% cases

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6
Q

How might a patient with EDH present

A
  1. Transient LOC (due to concussion)
  2. Transient recovery period (Lucid interval)
  3. Rapid decline in consciousness (enlarging haematoma causing RICP)
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7
Q

What are the findings on CT in EDH

A

Intracranial lesion
Bioconvex and hyperdense lesion (clot is denser than brain tissue)
Ventricular compression
Midline shift

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8
Q

What is the management of EDH

A

ABCDE assessment
Small: observe + conservative Mx
Large: craniotomy + clot evacuation

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9
Q

What are the complications of EDH

A

Permanent brain damage
Coma: RICP - herniation - brainstem compression
Seizures
Arteriovenous fistula

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10
Q

What is subdural haemorrhage

A

Collection of blood between dura mater and arachnoid mater

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11
Q

What vessels are involved in SDH

What are they

A

Bridging veins

Veins draining cerebral venous blood into dural venous sinuses

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12
Q

What is the mechanism of SDH

A

Shearing force on bridging veins:
Trauma
Falls

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13
Q

What age groups are affected by SDH

A

Acute: any
Chronic: elderly - recurrent falls, cortical atrophy cause tension on bridging veins

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14
Q

How might a patient with SDH present

A

Acute: reduced GCS and neurological abnormalities following trauma

Chronic: insidious onset of neurological decline

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15
Q

What are the findings on CT for SDH

A

Acute:
Intracranial
Biconcave + hyperdense lesion
Midline shift

Chronic: hypodense lesion (clot liquefies)

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16
Q

What is the management of SDH

A

Acute:
Immediate neurosurgical intervention
Craniotomy
Burr holes

Chronic:
Burr holes

17
Q

What is subarachnoid haemorrhage

A

Collection of blood in subarachnoid space between arachnoid and pia mater

18
Q

What vessels are involved in SAH

A

Circle of Willis

19
Q

What is the mechanism of SAH

A 
Berry aneurysm rupture 
At sites of bifurcation of circle of Willis 
95% anterior circulation: 
Bw ACA/Anterior communicating
Bw MCA/Posterior communicating 
Bw MCA/Branches
20
Q

What are risk factors of berry aneurysms

A

Hypertension
Family history
Abnormal connective tissue: Ehlers Danlos, Marfans
Autosomal dominant polycystic kidney disease

21
Q

What age group does SAH occur in

A

Middle aged (<60)

22
Q

How might someone with SAH present

A

Thunderclap headache

Meningism: photophobia, neck stiffness, headache, N+V

23
Q

How CNS you distinguish meningitis vs SAH

A

In meningitis:
Non-blanching petecheal rash
Fever, tachycardia (sepsis)

24
Q

What are the findings on CT for SAH

A

Intracerebral

Spider- shaped Hyperdense lesion

25
Q

What is the management of SAH

A

Bedside - fundoscopy
Bloods - serology, cultures
Imaging - CT Head
Procedures - Lumbar puncture

Stabilise patient
Prevent rebleeding
Treat cerebral vasospasm - Ca channel blockers
Correct hyponatraemia

26
Q

What are findings on lumbar puncture for SAH

A

Presence of RBC

Xanthochromia - yellow tinge in CSF

27
Q

What are complications of SAH

A

Hydrocephalus
Focal neurological deficits
Seizures
Coma

28
Q

What type of hydrocephalus can occur with SAH and why

A

Communicating

Functional impairment of arachnoid processes due to fibrosis of subarachnoid space
No obstruction to flow in ventricular system

29
Q

What are contraindications of Lumbar puncture and why

How can you identify this

A

RICP - risk of uncal herniation

Investigations to rule out RICP:
Fundoscopy
CT head

Neuro (18 decks)

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