Intracranial haemorrhage Flashcards
Extradural haemorrhage (epidural)
between the skull and the dural membrane- often as a result of head trauma, source of blood often arterial
extra dural haemorrhage symptoms
beware of deteriorating consciousness after head injury that originally produced no loss of consciousness.
Increasingly severe headache, vomiting, confusion, and seizures. If bleeding continues- ipsilateral pupil dilates, coma deepens, bilateral limb weakness develops, death due to resp arrest
Most common artery causing extra dural haemorrhage
middle meningeal artery- trauma to temple
Tests for extra dural haemorrhage
CT shows haematoma
management of extradural haematoma
neurosurgical unit for clot evacuation +/- ligation of the bleeding vessel
Subdural haematoma
between dura mater and arachnoid mater
when to consider subdural haematoma
conscious level fluctuating, having an evolving stroke- esp if on anticoagulants
most subdural come from trauma but it is often long forgotten - minor
where is bleeding from in subdural haematoma
bridging veins between cortex and venous sinuses
who is most susceptible to subdural
elderly- brain atrophy makes bridging veins more vulnerable. Also- alcoholics, anticoags
symptoms and signs of subdural
fluctuating levels of consciousness, insidious physical or intellectual slowing, sleepiness, headache, personality change, and unsteadiness
Imaging for subdural
CT/MRI shows clot +/- midline shift
what should you look for on imagine for subdural
crescent shaped collection of blood over one hemisphere
management of subdural
reverse clotting abnormalities urgently
clots >10mm or >5mm with midline shift need evacuating- via craniotomy or burr hole
SAH symptoms
Sudden onset excruciating headache, typically occipital (thunderclap), vomitting, collapse, seizures and coma often follow.
SAH signs
neck stiffness, kernigs sign (hip flexed, knee extension beyond 90 degrees painfull) takes 6h to develop, focal neurology at presentation may suggest site of aneurysm
