Intracranial Haemorrhage Flashcards
What are the types of intracranial haemorrhage
Extradural
Subdural
Subarachnoid
What is extradural haemorrhage
Collection of blood between inner surface of skull and dura mater (endosteal layer)
What vessels are involved in EDH
middle meningeal artery (90%)
What is the mechanism of EDH
Trauma - pterion fracture
What age group is EDH common in
Young: <20yo 50% cases
How might a patient with EDH present
- Transient LOC (due to concussion)
- Transient recovery period (Lucid interval)
- Rapid decline in consciousness (enlarging haematoma causing RICP)
What are the findings on CT in EDH
Intracranial lesion
Bioconvex and hyperdense lesion (clot is denser than brain tissue)
Ventricular compression
Midline shift
What is the management of EDH
ABCDE assessment
Small: observe + conservative Mx
Large: craniotomy + clot evacuation
What are the complications of EDH
Permanent brain damage
Coma: RICP - herniation - brainstem compression
Seizures
Arteriovenous fistula
What is subdural haemorrhage
Collection of blood between dura mater and arachnoid mater
What vessels are involved in SDH
What are they
Bridging veins
Veins draining cerebral venous blood into dural venous sinuses
What is the mechanism of SDH
Shearing force on bridging veins:
Trauma
Falls
What age groups are affected by SDH
Acute: any
Chronic: elderly - recurrent falls, cortical atrophy cause tension on bridging veins
How might a patient with SDH present
Acute: reduced GCS and neurological abnormalities following trauma
Chronic: insidious onset of neurological decline
What are the findings on CT for SDH
Acute:
Intracranial
Biconcave + hyperdense lesion
Midline shift
Chronic: hypodense lesion (clot liquefies)
What is the management of SDH
Acute:
Immediate neurosurgical intervention
Craniotomy
Burr holes
Chronic:
Burr holes
What is subarachnoid haemorrhage
Collection of blood in subarachnoid space between arachnoid and pia mater
What vessels are involved in SAH
Circle of Willis
What is the mechanism of SAH
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
What are risk factors of berry aneurysms
Hypertension
Family history
Abnormal connective tissue: Ehlers Danlos, Marfans
Autosomal dominant polycystic kidney disease
What age group does SAH occur in
Middle aged (<60)
How might someone with SAH present
Thunderclap headache
Meningism: photophobia, neck stiffness, headache, N+V
How CNS you distinguish meningitis vs SAH
In meningitis:
Non-blanching petecheal rash
Fever, tachycardia (sepsis)
What are the findings on CT for SAH
Intracerebral
Spider- shaped Hyperdense lesion
What is the management of SAH
Bedside - fundoscopy
Bloods - serology, cultures
Imaging - CT Head
Procedures - Lumbar puncture
Stabilise patient
Prevent rebleeding
Treat cerebral vasospasm - Ca channel blockers
Correct hyponatraemia
What are findings on lumbar puncture for SAH
Presence of RBC
Xanthochromia - yellow tinge in CSF
What are complications of SAH
Hydrocephalus
Focal neurological deficits
Seizures
Coma
What type of hydrocephalus can occur with SAH and why
Communicating
Functional impairment of arachnoid processes due to fibrosis of subarachnoid space
No obstruction to flow in ventricular system
What are contraindications of Lumbar puncture and why
How can you identify this
RICP - risk of uncal herniation
Investigations to rule out RICP:
Fundoscopy
CT head
