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Neurology > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

Name the 3 different types of spontaneous intracranial haemorrhage.

A
  • Subarachnoid
  • Intracerebral
  • Intraventricular
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2
Q

What is a subarachnoid haemorrhage?

A

Bleeding into the subarachnoid space

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3
Q

If a diagnosis of an SAH is missed, it can be fatal

A

TRUE

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4
Q

Even with treatment, what is the 30 day mortality of SAH?

A

46%

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5
Q

What is there usually underlying in an SAH?

A

Berry aneurysm

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6
Q

What else can an SAH be due to?

A

AVM

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7
Q

What symptoms does SAH usually present with?

A
  • Sudden onset severe headache
  • Collapse.
  • Vomiting.
  • Neck pain.
  • Photophobia.
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8
Q

What may a patient describe the pain of an SAH as?

A

Like being hit on the back of the head with an axe

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9
Q

Name 3 differentials of a sudden onset severe headache.

A
  • SAH
  • Migraine
  • Benign coital cephalgia
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10
Q

What signs are associated with SAH?

A
  • Neck stiffness.
  • Photophobia.
  • Decreased conscious level.
  • Focal neurological deficit (dysphasia, hemiparesis, IIIrd nerve palsy).
  • Fundoscopy – retinal or vitreous haemorrhage.
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11
Q

Why will most patients with SAH not let you do fundoscopy?

A

They usually have very severe photophobia and thus do not want a light shone in their eye

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12
Q

What is the sign of a 3rd nerve palsy?

A

Dilated pupil, directed downwards and outwards

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13
Q

What is THE diagnostic test of SAH?

A

CT

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14
Q

If a CT is negative in SAH, what should be done?

A

Lumbar puncture

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15
Q

Why might a CT be negative in SAH?

A

> 3 days post -ictus

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16
Q

How does fresh blood appear on a CT?

A

Hyperdense - white

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17
Q

Who is an LP safe in?

A
  • Alert pts with no focal neurological deficit, and no papilloedema

OR

  • After normal CT scan
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18
Q

In the context of SAH, what results would you expect from a lumbar puncture? When?

A

Bloodstained or xanthochromic CSF (6-48hr) – yellow CSF due to breakdown of blood

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19
Q

What do you need to differentiate between in a lumbar puncture with blood?

A

Traumatic tap

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20
Q

How do you know if it is a traumatic tap and not SAH?

A

Take 3 samples - if the 1st one contains blood but the 3rd one is clear then it can be said to be a traumatic tap

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21
Q

Describe cerebral angiography.

A
  • Seldinger technique via femoral artery
  • Digital Subtraction
  • 4 vessel angiography with multiple views
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22
Q

What test is GOLD standard but may miss an aneurysm due to vasospasm?

A

Cerebral angiography

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23
Q

Mushroom cloud

A

Aneurysm

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24
Q

What are the 5 main complications of an SAH that you must be aware of?

A
  • Re-bleeding. (MAIN CONCERN)
  • Delayed ischaemic deficit.
  • Hydrocephalus.
  • Hyponatraemia.
  • Seizures.
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25
Q

Re-bleeds are _____

A

FATAL

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26
Q

What 2 techniques can be used to reduce the risk of a re-bleed?

A
  • Endovascular techniques

* Surgical clipping

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27
Q

What may delayed ischaemia lead to?

A

Delayed Ischaemic Neurological Deficit (DIND).

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28
Q

In what days are most people most vulnerable to delayed ischaemia?

A

days 3-12

29
Q

How does delayed ischaemic manifest itself?

A

With altered conscious level or focal deficit

30
Q

Delayed ischaemia is due to what?

A

VASOSPASM

31
Q

What drug is given to treat delayed ischaemia?

A

NIMODIPINE

32
Q

What kind of drug is nimodipine?

A

Ca channel blocker

33
Q

As well as Nimodipine, what else is used to treat delayed ischaemia?

A

High Fluid Intake  ‘Triple H Therapy.’

    • Hypervolaemia.
    • Haemodilution.
    • Hypertension.
34
Q

What is hydrocephalus?

A

Increased intracranial CSF pressure

35
Q

What is hydrocephalus known colloquially as?

A

‘water on the brain’

36
Q

What are the main symptoms associated with hydrocephalus?

A
  • Increasing headache.

* Altered conscious level.

37
Q

Most people with ___ get hydrocephalus

A

SAH

38
Q

What treatment options are available for hydrocephalus?

A

CSF drainage, either with:

  • Lumbar puncture.
  • External Ventricular Drain (EVD).
  • Shunt (if something more permanent is needed).
39
Q

Hydrocephalus is often ___________

A

TRANSIENT

40
Q

What does hyponatraemia occur due to?

A

SIADH
or
‘Cerebral salt wasting.’

41
Q

Hyponatraemia is often ____________

A

TRANSIENT

42
Q

What should you not do in someone with hyponatraemia? Why?

A

Fluid restrict.

  • blood will circulate less well, and will predispose pt to delayed ischaemia.
43
Q

How should you manage a patient with hyponatraemia caused by SAH?

A
  • Supplement sodium intake.

* Give fludrocortisone.

44
Q

How is the risk of seizures managed in a patient with SAH?

A

Prophylactic anti-convulsants

45
Q

What should you always think if a patient presents with a sudden onset severe headache for the first time?

A

‘Could this be SAH?’

46
Q

What should you always do if a patient presents with SAH?

A
  1. Bedrest, analgesia, anti-emetic, IV fluids
  2. CT
  3. LP if CT negative
  4. Refer to neurosurgery
47
Q

What is an intracerebral haemorrhage?

A

Bleed into brain parenchymal

48
Q

What are 50% of ICH’s due to?

A

Hypertension

49
Q

What are 30% of ICH’s due to?

A

Aneurysm, or arteriovenous malformation

50
Q

Describe the headache in ICH.

A

These also cause a headache, but it is not as sudden and dramatic as that in SAH.

51
Q

What is hypertensive ICH associated with?

A
  • ‘Charcot-Bouchard’ microaneurysms, arising on small perforating arteries.
  • Basal ganglia haematoma
52
Q

Outline the presentation of ICH.

A
  • Headache
  • Focal neurological deficit. (hemiplegia or hemiparesis)
  • Decreased conscious level
53
Q

What is the GOLD standard investigation in ICH?

A

CT

54
Q

When should a CT be done urgently in ICH?

A

If the patient has a decreased conscious level

55
Q

When should angiography be done in someone with ICH?

A

If there is suspicion of underlying vascular anomaly.

note: most are due to hypertension, not a vascular abnormality

56
Q

How is ICH managed?

A

With SURGICAL EVACUATION OF HAEMATOMA +/- treatment of underlying abnormality

OR

Non-surgical

57
Q

When is the prognosis of ICH good?

A

If there is a small superficial clot, and good neurological status

58
Q

When is the prognosis of ICH poor?

A

If there is a large basal ganglia or thalamic clot, with a major focal deficit or deep coma

59
Q

What does an intraventricular haemorrhage occur due to?

A

Rupture of a subarachnoid or intracerebral bleed into a ventricle

60
Q

Any combination of what can occur in an intraventricular haemorrhage?

A

Subarachnoid, intracerebral and intraventricular haemorrhage

61
Q

What do AV malformations result in?

A

AV shunt

62
Q

What – in terms of location – are AVM’s usually?

A

Intraparenchymal

63
Q

AVM’s may be _________

A

CONGENTIAL

64
Q

What are AVM’s associated with?

A

Seizures

Headache

65
Q

What type of haemorrhage can AVM’s be associated with?

A

Intracerebral
Subarachnoid
Subdural

66
Q

Steal syndrome seen in AVM’s can be described as……

A

Pull arterial blood from other arteries of the brain

67
Q

What are the treatment options for AVM’s?

A
  • Surgery
  • Endovascular embolization
  • Stereotactic radiotherapy
  • Conservative
68
Q

What must always be done when deciding on a treatment option for AVM’s?

A

Outweigh benefits and risks

69
Q

Name some random causes of spontaneous intracranial haemorrhage.

A

Bleeding diatheses
Tumours
Drugs (warfarin, heparin)

Neurology (42 decks)

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