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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 a 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 the CSF space after aneurysm ruptures (normally this pressure =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
  • CN III palsy - due to compression from bleed
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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 themself, 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 X-Rays

Blood - rich in ions => lots of electrons to pick up X-Rays

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9
Q

Explain the appearance of a 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 (don't 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 is in the CSF

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12
Q

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

A

Femoral artery feeds catherter up to each artery supplying brain
- allows injection of contrast

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13
Q

Why would 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

=> causing 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 used to “plug” aneurysm

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 chances of vasospasm after subsarachnoid 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” fluid 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 the dead brain

23
Q

What consequence of a subarachnoid haemorrhage can cause hydrocephalus?

A

inflammatory products from the bleed can bock either:

  • CSF pathways
  • Arachnoid granulations
24
Q

How is hydrocephalus treated?

A

External ventricular drain (EVD)

VP Shunt

25
Q

What symptom 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/FALSE?

A

FALSE
encourage normal fluid intake
give fludrocortisone to offload fluid but preserve Na

28
Q

What name is given to a bleed straight into the brain parenchyma?

A

Intracerebral bleed

29
Q

What are the most common causes of an intracerebral bleed?

A

Hypertension

some due to aneurysm or AVM

30
Q

How do intracerebral haemorrhages usually present?

A
  • Headache (not as sudden onset as SAH)
  • Focal neurological deficit (haemorrhagic stroke)
  • Decreased conscious level (raised ICP due to bleed decreases cerebral perfusion)
31
Q

What investigations are used in intracerebral haemorrhage?

A

CT scan - urgent if decreased conscious level

Angiography if suspicion of underlying vascular anomaly

32
Q

When should patients with an intracerebral haemorrhage be treated?

A
  • Surgical evacuation of haematoma if losing consciousness

- Treatment of underlying abnormality if applicable

33
Q

What types of intrecerebral clots have poor prognosis?

A
  • large basal ganglia or thalamic clot

- major focal deficit or deep coma

34
Q

What is meant by an intraventricular haemorrhage?

A

rupture of a subarachnoid or intracerebral bleed into a ventricle

35
Q

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

A

occipital wall of lateral ventricles

due to pt lying on their back

36
Q

What symptoms do arterio-venous 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)

37
Q

How can AVMs be treated?

A
  • Surgery (draining veins clipped)
  • Endovascular embolisation (adjunct to surgery)
  • Stereotactic radiotherapy (gamma rays closes it up)
38
Q

How do AVMs appear on an angiogram?

A

“storm cloud” appearance

39
Q

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

A

Antiplatelets - aspirin, clopidogrel

Anticoagulants - warfarin, DOACs

NEUROLOGY (29 decks)

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