Intracranial Haemorrhage Flashcards
name the 3 types of spontaneous intracranial haemorrhage
subarachnoid
intracerebral
intraventricular
what bifurcation sites are a common formation point for berry aneurysms?
bifurcation of: basilar middle cerebral where ant cerebral meets ant communicating post comm arising from internal carotid
the headache persists in SAH T or F
T
why do you get neck pain, photophobia and nausea in SAH?
blood in the spinal SA space irritates the meninges
how is SAH different in presentation from meningitis?
SAH is SUDDEN
if a headache takes more than _ mins to peak, its probably benign
5
sudden onset headache DDx
SAH
migraine
benign coital cephalgia
define benign coital cephalgia; when does the headache start?
extreme onset headache during sex, usually just before orgasm
what could present on fundoscopy in a patient with SAH?
retinal or vitreous haemorrhage
why is blood dense on CT
full of electrons so stops the CT going through it
when should you do LP in a suspected SAH patient?
alert patient with:
no focal neuro deficit
no papilloedema
normal CT scan
what is xanthochromic CSF?
CSF that has turned yellow from blood breakdown products
how could you differentiate a traumatic tap (touching a vein accidentally) from true bloodstained CSF?
take 3 samples and label 1, 2 and 3
if the last bottle has less blood than the first its a traumatic tap
gold standard test for berry aneurysm?
cerebral angiography
how is contrast given for CT angiography
IV
main electrolyte disturbance in SAH
hyponatraemia
how are aneurysms treated
- endovascular treatment
surgical clipping
how many days after a bleed does delayed ischaemia present?
day 3-12
presentation of delayed ischaemia?
altered conscious level
focal neuro deficit
how is delayed ischaemia prevented?
hydrate patient
Ca channel blocker to prevent vasospasm
how is hydrocephalus treated in an emergency?
LP to drain CSF
why should you NOT fluid restrict in hyponatraemia from SAH? what should be done instead?
puts the patient at risk of ischaemia
give sodium - fludrocortisone
what should be done while you’re waiting on the diagnosis in SAH?
bedrest
analgesia
anti-emetic
IV fluids
charcot-bouchard microaneurysms cause what type of haemorrhage?
hypertensive intracerebral haemorrhage
presentation of ICH
headache
focal neuro deficit
decreased conscious level
non-surgical management of ICH is ideal T or F
T
Ix of ICH
CT
angiography if you’re thinking of a vascular anomaly
cause of intraventricular haemorrhage?
rupture of a subarachnoid or intracerebral bleed into a ventricle
presentation of AVMs
seizures
haemorrhage
headache
progressive ischaemia
