Intracranial Haemorrhage Flashcards
What are the types of spontaneous intracranial haemorrhage?
Subarachnoid, intracerebral and intraventricular
What is a subarachnoid haemorrhage?
Bleeding into the subarachnoid space = 46% mortality at 30 days even with treatment
Causes = AVM, berry aneurysm, spontaneous
How do subarachnoid haemorrhages present?
Sudden onset severe headache, collapse, nausea/vomiting, neck pain and photophobia
Focal neurological deficit = dysphagia, hemiparesis, CN III palsy
What are the differentials of a subarachnoid haemorrhage?
Migraine or benign coital cephalgia
What may be seen on fundoscopy of a patient with a subarachnoid haemorrhage?
Retinal or vitreous haemorrhage
What investigations are done for subarachnoid haemorrhages?
CT, lumbar puncture and cerebral angiography
What are some features of a CT scan of a patient with a subarachnoid haemorrhage?
May be negative if >3 days post-ictus
Negative in 15% who have bled
What are some features of a lumbar puncture of a patient with a subarachnoid haemorrhage?
Safe if normal CT or alert patient with no focal neurological deficit and no papilloedema
Bloodstained or xanthochromatic CSF (6-48hrs)
What are the complications of a subarachnoid haemorrhage?
Rebleeding, delayed ischaemic deficit, hydrocephalus, hyponatraemia, seizures
What are some features of a cerebral angiography in a patient with a subarachnoid haemorrhage?
Gold standard = Selder technique via femoral artery, 4 vessel angiography with multiple views
May miss aneurysm
What are some features of rebleeding after a subarachnoid haemorrhage?
Often fatal = 20% risk in first 14 days, 50% risk in first 6 months
What are some features of a delayed ischaemic deficit following a subarachnoid haemorrhage?
Days 3-12 usually
Altered conscious level or focal deficit
Treat with nimodipine and high fluid intake
How is hyponatraemia caused by a subarachnoid haemorrhage treated?
Fludrocortisone
What is the prognosis of a subarachnoid haemorrhage?
50% die in first month
50% of survivors have a major disability
What is a intracerebral haemorrhage?
Bleeding into the brain parenchyma = 50% secondary to hypertension, 30% due to AVM or aneurysm
What are some causes of a hypertensive intracerebral haemorrhage?
Charcot-Bouchard microaneurysms arising on small perforating arteries
Basal ganglia haematomas
What is the presentation of an intracerebral haemorrhage?
Headache, focal neurological deficit, decreased conscious level
What investigations are done for intracerebral haemorrhages?
CT = urgent if decreased conscious level
Angiography if suspicion of underlying vascular anomaly
What is the treatment for intracerebral haemorrhages?
Surgical evaluation of haematoma +/- treatment of underlying abnormality
What is the prognosis of an intracerebral haemorrhage?
Good prognosis of small superficial clot and good neurological status
Poor prognosis if large basal ganglia or thalamic clot with major focal deficit or deep coma
What causes an intraventricular haemorrhage?
Rupture of a subarachnoid or intracerebral bleed into a ventricle
What are arteriovenous malformations (AVMs)?
Arterio-venous shunts = usually intraparenchymal
What are the symptoms of an AVM?
Seizures, haemorrhage, headache, steal syndrome
What is the treatment of AVMs?
Surgery, endovascular embolisation, stereotactic radiotherapy, conservative
What is first line for imaging aneurysms?
DSA = digital subjective angiography
