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Neurology > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

what fluid does a subarachnoid haemorrhage bleed into?

A

CSF

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2
Q

what are the most common reasons for a subarachnoid haemorrhage to occur?

A

berry aneurysm

sometimes AVM

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3
Q

where in the circle of willis are berry aneurysms usually found?

A

junctions between branching arteries

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4
Q

what is the main presenting feature of subarachnoid haemorrhage and why?

A

sudden onset severe headache (often described as being hit with brick/baseball bat)

due to full systolic blood pressure entering CSF space after aneurysm ruptures (normally this pressure is 0)

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5
Q

why can subarachnoid haemorrhages cause symptoms similar to that of meningitis?

A

rupture of aneurysm causes release of inflammatory chemicals into CSF space

irritation of meninges causes neck pain and stiffness and photophobia

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6
Q

other than symptoms of meningitis, what can present in a subarachnoid haemorrhage?

A

decreased conscious level
neurological deficit
retinal / vitreous haemorrhage on fundoscopy
CNIII plasy due to compression

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7
Q

what are the potential differentials for a sudden onset headache?

A

subarachnoid haemorrhage
migraine
benign coital cephalgia (due to patient over exerting themselves, often during sex)

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8
Q

why does CSF appear black on CT whilst acute blood appears hyperintense?

A

CSF - not a lot of electrons to pick up xrays

blood - rich in ions so lots of electrons to pick up xrays

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9
Q

explain the appearance of subarachnoid haemorrhage on CT?

A

hyperintense distribution in shape of circle of willis in centre of image

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10
Q

if a CT scan for a suspected subarachnoid haemorrhage is negative, what further investigation should be done and what can be found?

A

lumbar puncture (dont delay unless contraindicated)

either blood stained CSF or xanthochromic appearance (yellow due to blood break down products)

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11
Q

what is meant by a traumatic tap?

A

blood is found in lumbar puncture due to rupturing a small vessel when taking the sample
not because blood in CSF

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12
Q

what artery is catheterised during a CT angiogram of the head?

A

femoral artery feeds catheter up to each artery supplying brain - allows injection of contrast

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13
Q

why would a contrast appear to be escaping on a CT angiogram?

A

aneurysm has ruptured and contrast is leaking and forming a haematoma

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14
Q

what are the main complications of subarachnoid haemorrhage?

A 
re-bleeding 
delayed ischaemic deficit 
hydrocephalus 
hyponatraemia 
seizures
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15
Q

why do aneurysms usually stop bleeding relatively quickly?

A

arteries go into vasospasm - causes clotting

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16
Q

how are aneurysms walled off from the main circulation to prevent re-bleeding?

A

clipping of aneurysm

endovascular techniques - platinum coils to plug aneurysm

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17
Q

what causes delayed ischaemia after a subarachnoid haemorrhage?

A

inflammatory chemicals cause irritation of other vessels

vessels spasm and constrict - cause a stroke

18
Q

how soon after a subarachnoid haemorrhage does delayed ischaemia usually occur?

A

days 3-12

19
Q

what symptoms usually present if a patient has developed delayed ischaemia?

A

altered conscious level

focal neurological deficit

20
Q

what drug can be given to reduce the chances of vasospasm after subarachnoid haemorrhage?

A

nimodipine - Ca2+ channel blocker

21
Q

a good fluid intake should be maintained after a subarachnoid haemorrhage - what is meant by “triple H” therapy?

A

hypervolaemia - central line fluids
hypertension - give inotropes
haemodilution (dilute the blood)

22
Q

ischaemic areas of the brain appear dark on CT, but what are any hyperintense lesions inside this section?

A

secondary bleeding into dead brain

23
Q

what consequence of a subarachnoid haemorrhage can cause hydrocephalus?

A

inflammatory products from the bleed can block either CSF pathways or arachnoid granulations

24
Q

how is hydrocephalus treated?

A

external ventricular drain (EVD)

VP shunt

25
Q

what symptoms indicates a patient who has had a recent subarachnoid haemorrhage may be developing hydrocephalus?

A

headache getting worse again 1 week after event

decreased conscious level if raised ICP has decreased cerebral perfusion

26
Q

how can a subarachnoid bleed cause a hyponatraemia?

A

hypothalamic axis is impaired after bleed

SIADH occurs - water retention, sodium dilution, hyponatraemia (cerebral salt wasting)

27
Q

patients with hyponatraemia post subarachnoid haemorrhage should be fluid restricted - true or false?

A

false
encourage normal fluid intake
give fludrocortisone to offload fluid by preserve Na

28
Q

anticonvulsant prophylaxis should be given in subarachnoid haemorrhage - true or false?

A

true

29
Q

what is the basic summary of SAH treatment?

A

bed rest, analgesia, anti-emetic, IV fluids

30
Q

what name is given to a bleed straight into brain parenchyma?

A

intracerebral bleed

31
Q

what are the most common causes of an intracerebral bleed?

A

hypertension (some due to aneurysm or AVM)

32
Q

how do intracerebral haemorrhages usually present?

A

headache (not as sudden as SAH)
focal neurological deficit (haemorrhagic stroke)
decreased consciousness level (raised ICP due to bleed decreases cerebral perfusion)

33
Q

what investigations are used in intracerebral haemorrhage?

A

CT scan - urgent if decreased conscious level

angiography if suspicion of underlying vascular anomaly

34
Q

when should patients with an intracerebral haemorrhage be treated?

A

surgical evacuation of haematoma if losing consciousness

treatment of underlying abnormality if applicable

35
Q

what types of cerebral clots have poor prognosis?

A

large basal ganglia or thalamic clot

major focal deficit or deep coma

36
Q

what is meant by an intraventricular haemorrhage?

A

rupture of a subarachnoid or intracerebral bleed into ventricle

37
Q

what area on CT scan is most sensitive to seeing intraventricular haemorrhage?

A

occipital wall of lateral ventricles (due to pt lying on back)

38
Q

what symptoms do arterio-venouos malformations (AVMs) usually cause?

A

seizures
bleeding
headache (due to high arterial pressure in brain)
steal syndrome (pooling of arterial blood away from normal vessels causing ischaemia)

39
Q

how can AVMs be treated?

A 
surgery (draining vein clipped)
endovascular embolisation (adjunct to surgery)
stereotactic radiotherapy (gamma rays closes it up)
40
Q

how to AVMs appear on an angiogram?

A

storm cloud appearance

41
Q

what types of drugs make surgery high risk on certain patients?

A

antiplatelets - aspirin, clopidogrel

anticoagulants - warfarin, DOACs

Neurology (32 decks)

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