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
