Intracranial Haemorrhage Flashcards
what is a intracranial venous thrombosis
a venous infarction that can develop in any of the dural venous sinuses
what are the risk factors for developing intracranial venous thrombosis
pregnancy COCP, transexamic acid use dehydration malignancy head injury
how does a sagittal sinus thrombosis present
headache vomiting seizures reduced vision papilloedema
how does a transverse sinus thrombosis present
headache
mastoid pain
focal seizures
papilloedema
what structures pass through the cavernous sinus
CN 3, 4, 5 (1/2) and 6
internal carotid
sympathetic fibres
what is the most likely cause of cavernous sinus thrombosis
infection spread from the face
how does cavernous sinus thrombosis present
ophthalmoplegia ptosis fever focal neurology raised ICP
how is a sinus thrombosis managed
anticoagulation such as heparin, warfarin or streptokinase
manage symptoms of raised ICP
what does a subarachnoid haemorrhage bleed into
the subarachnoid space between the dura and pia mater
what is the most common cause of SAH and what conditions predispose to this
rupture of berry aneurysm
conditions such as PKD, Enhler Danlos and coarctation of the aorta predispose to this
other than rupture of berry aneurysm, what else causes SAH
arteriovenous malformation
vasculitis
bifurcation of cerebral arteries is a common site for which intracranial bleed
SAH
describe the headache felt in SAH
sudden onset, worst ever headache - thunderclap
can occur when lifting heavy objects or having sex
what are the other clinical features of SAH
collapse
decreased or loss of consciousness
meningism - photophobia and neck stiffness
3rd nerve palsy
what is the first line investigation for suspected SAH
CT but sensitivity reduces over time, shows grey areas within normally dark ventricles
what are the lumbar puncture findings of SAH
xanthochromic CSF - turns yellow due to breakdown of RBCs but takes at least 6 hours to develop
what is the acute management of SAH
maintain cerebral perfusion by inducing hypertension with IV saline
what drug can help with SAH and why
nimodipine, CCB that reduces the chance of cerebral artery spasm and ischaemia
what is the surgical management for SAH
aneurysm clipping and repair
what is the main complications of SAH
re-bleeding, often fatal
delayed ischaemia
hydrocephalus
hyponatraemia - manage with sodium supplements
is a subdural haemorrhage venous or arterial blood
venous
where does a subdural haemorrhage occur
in the bridging veins connecting the dural venous sinuses
blood accumulates between the dura and arachnoid mater
what are the main risk factors for developing a subdural haemorrhage
increased age
alcoholism
epilepsy
anti-coags
what events usually leads up to a subdural haemorrhage
usually in the context of low impact trauma that the individual sometimes cannot remember
how does a subdural haemorrhage present
fluctuations in consciousness sleepiness dull headache unsteadiness focal neurology onset of symptoms is slow and insidious
what are the CT findings seen in a subdural haemorrhage
crescent/sickle shaped haematoma
not confined to the cranial suture lines
features of midline shift also seen
how is a subdural haemorrhage managed
prophylactic anti-epileptics
surgery if expanding haematoma, burr hole craniotomy or craniotomy
where does the bleed arise in an epidural haemorrhage
usually middle meningeal artery
where does blood pool in an epidural haemorrhage
between the dura and the temporal bone
a young person presenting with recent temporal bone fracture/trauma most likely has what
epidural haemorrhage
how does an epidural haemorrhage present
head injury followed by lucid period
increasingly severe headache then sudden decline in consciousness + confusion, seizures, vomiting, hemiparesis, focal neurology and signs of raised ICP
what are the CT findings of an epidural haematoma
lemon/lens/biconvex haemorrhage that is confined to cranial sutures
how is an epidural haemorrhage managed
stabilise and transfer to neurosurgical unit for clot stabilisation and ligation of middle meningeal artery
