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Year 4: Neurology > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

what are the types of spontaneous intracranial haemorrhage

A

Subarachnoid Haemorrhage
Intracerebral Haemorrhage
Intraventricular Haemorrhage

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2
Q

what is a SAH

A

bleeding into the subarachnoid space

fatal if diagnosis missed

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3
Q

what can cause a SAH

A
  • berry aneurysm (most commonly)
  • AVM
  • no underling cause found
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4
Q

Sx of SAH

A 
Sudden onset severe headache
Collapse
Vomiting
Neck pain
Photophobia
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5
Q

Signs of SAH

A

Neck stiffness
Photophobia
Decreased conscious level
Focal neurological deficit (dysphasia, hemiparesis, IIIrd n. palsy)
Fundoscopy - retinal or vitreous haemorrhage

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6
Q

what Sx in the eye would mean a patient should urgently be investigated for SAH

A

Painful oculomotor nerve palsy - painful eye and dilated pupil

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7
Q

why might a CT scan not be useful in certain time frames

A

may be negative if >3days post attack

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8
Q

what patients are safe to have a LP

A

Safe in alert patient with no focal neurological deficit and no papilloedema, or after normal CT scan

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9
Q

what is CSF suggestive of SAH

A

bloodstained or xanthochromic (yellowish) CSF

6-48hr

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10
Q

what do you need to be careful with CSF samples

A

‘traumatic tap’

blood in the CSF from the invasive LP technique

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11
Q

what is the gold standard test for SAH

A

cerebral angiography

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12
Q

what are complications of SAH

A 
Re-bleeding
Delayed ischaemic deficit
Hydrocephalus - increased pressure due to accumulation of CSF
Hyponatraemia
Seizures
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13
Q

what are the forms of treatment to prevent re-bleeding

A

1st line - Endovascular techniques

2nd line - Surgical clipping

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14
Q

what is delayed ischaemic neurological deficit (DIND)

A

brain becomes ischaemic as the blood vessels go into spasm

altered/decreasing conscious level
focal deficit

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15
Q

when does DIND occur

A

between day 3 to 12

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16
Q

what drug is used in SAH to decrease disability caused by DIND

A

Nimodipine

17
Q

what predisposes patient to DIND

A

dehydration

18
Q

what is hydrocephalus and Sx of it

A

Increased intracranial CSF pressure

Increasing headache or altered conscious level

19
Q

Tx of hydrocephalus

A

CSF drainage - LP, Shunt, external ventricular drainage

20
Q

what is given to Tx or prevent hyponatraemia

A

fludrocortisone

21
Q

what is intracerebral haemorrhage

A

bleeding into brain parenchyma

22
Q

what are causes of intracerebral haemorrhage (ICH)

A
  • secondary to hypertension (most common cause)
  • aneurysm or AVM
  • alcohol, amphetamines, cocaine
  • cavernous haemangioma
23
Q

what features in the brain are associated with hypertensive ICH

A

‘Charcot- Bouchard’ microaneurysms arising on small perforating arteries

Basal ganglia haematoma

24
Q

what are the Sx of ICH

A 
headache
focal neurological deficit
decreased conscious level 
nausea and vomiting 
papilloedma
25
Q

Ix of ICH

A

1st line - CT scan

Angiography if suspicion of underlying vascular anomaly

26
Q

Tx of ICH

A

Surgical evacuation of haematoma +/-treatment of underlying abnormality

27
Q

what is intraventricular haemorrhage (IVH)

A

rupture of a subarachnoid or intracerebral bleed into a ventricle

Any combination of subarachnoid, intracerebral and intraventricular haemorrhage can occur

28
Q

what causes death in IVH

A

obstructive hydrocephalus

29
Q

Sx of IVH

A 
Sudden onset of severe headache
photophobia
nausea and vomiting 
neck stiffness
LOC, seizures
30
Q

Ix of IVH

A

1st line = non contrast CT

2nd line = MRI

31
Q

Tx for IVH

A

Tx underling cause of haemorrhage

Tx obstructive hydrocephalus

32
Q

what are the 2 different forms of IVH

A

Primary - dominant finding blood in the ventricles

Secondary - bleed somewhere else with extension into the ventricles

33
Q

where are AVM usually

A

intraparenchymal

34
Q

Sx of an AVM

A

Seizures
Haemorrhage – intracerebral, subarachnoid, subdural
Headache

35
Q

what syndrome can AVM cause

A

Steal syndrome

- can steal blood from the surrounding brain causing an ischaemia

36
Q

Tx for AVM

A

Surgery

Endovascular embolisation

37
Q

what is pontine haemorrhage due to

A

HTN

38
Q

symptoms of pontine haemorrhage

A

quadriplegia
miosis
decreased GCS

Year 4: Neurology (24 decks)

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