Intracranial Haemorrhage Flashcards
what are the types of spontaneous intracranial haemorrhage
Subarachnoid Haemorrhage
Intracerebral Haemorrhage
Intraventricular Haemorrhage
what is a SAH
bleeding into the subarachnoid space
fatal if diagnosis missed
what can cause a SAH
- berry aneurysm (most commonly)
- AVM
- no underling cause found
Sx of SAH
Sudden onset severe headache Collapse Vomiting Neck pain Photophobia
Signs of SAH
Neck stiffness
Photophobia
Decreased conscious level
Focal neurological deficit (dysphasia, hemiparesis, IIIrd n. palsy)
Fundoscopy - retinal or vitreous haemorrhage
what Sx in the eye would mean a patient should urgently be investigated for SAH
Painful oculomotor nerve palsy - painful eye and dilated pupil
why might a CT scan not be useful in certain time frames
may be negative if >3days post attack
what patients are safe to have a LP
Safe in alert patient with no focal neurological deficit and no papilloedema, or after normal CT scan
what is CSF suggestive of SAH
bloodstained or xanthochromic (yellowish) CSF
6-48hr
what do you need to be careful with CSF samples
‘traumatic tap’
blood in the CSF from the invasive LP technique
what is the gold standard test for SAH
cerebral angiography
what are complications of SAH
Re-bleeding Delayed ischaemic deficit Hydrocephalus - increased pressure due to accumulation of CSF Hyponatraemia Seizures
what are the forms of treatment to prevent re-bleeding
1st line - Endovascular techniques
2nd line - Surgical clipping
what is delayed ischaemic neurological deficit (DIND)
brain becomes ischaemic as the blood vessels go into spasm
altered/decreasing conscious level
focal deficit
when does DIND occur
between day 3 to 12
what drug is used in SAH to decrease disability caused by DIND
Nimodipine
what predisposes patient to DIND
dehydration
what is hydrocephalus and Sx of it
Increased intracranial CSF pressure
Increasing headache or altered conscious level
Tx of hydrocephalus
CSF drainage - LP, Shunt, external ventricular drainage
what is given to Tx or prevent hyponatraemia
fludrocortisone
what is intracerebral haemorrhage
bleeding into brain parenchyma
what are causes of intracerebral haemorrhage (ICH)
- secondary to hypertension (most common cause)
- aneurysm or AVM
- alcohol, amphetamines, cocaine
- cavernous haemangioma
what features in the brain are associated with hypertensive ICH
‘Charcot- Bouchard’ microaneurysms arising on small perforating arteries
Basal ganglia haematoma
what are the Sx of ICH
headache focal neurological deficit decreased conscious level nausea and vomiting papilloedma
Ix of ICH
1st line - CT scan
Angiography if suspicion of underlying vascular anomaly
Tx of ICH
Surgical evacuation of haematoma +/-treatment of underlying abnormality
what is intraventricular haemorrhage (IVH)
rupture of a subarachnoid or intracerebral bleed into a ventricle
Any combination of subarachnoid, intracerebral and intraventricular haemorrhage can occur
what causes death in IVH
obstructive hydrocephalus
Sx of IVH
Sudden onset of severe headache photophobia nausea and vomiting neck stiffness LOC, seizures
Ix of IVH
1st line = non contrast CT
2nd line = MRI
Tx for IVH
Tx underling cause of haemorrhage
Tx obstructive hydrocephalus
what are the 2 different forms of IVH
Primary - dominant finding blood in the ventricles
Secondary - bleed somewhere else with extension into the ventricles
where are AVM usually
intraparenchymal
Sx of an AVM
Seizures
Haemorrhage – intracerebral, subarachnoid, subdural
Headache
what syndrome can AVM cause
Steal syndrome
- can steal blood from the surrounding brain causing an ischaemia
Tx for AVM
Surgery
Endovascular embolisation
what is pontine haemorrhage due to
HTN
symptoms of pontine haemorrhage
quadriplegia
miosis
decreased GCS
