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Neurology > Intracranial Haemorrhage > Flashcards

Intracranial Haemorrhage Flashcards

1
Q

what is a intracranial venous thrombosis

A

a venous infarction that can develop in any of the dural venous sinuses

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2
Q

what are the risk factors for developing intracranial venous thrombosis

A 
pregnancy
COCP, transexamic acid use 
dehydration 
malignancy 
head injury
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3
Q

how does a sagittal sinus thrombosis present

A 
headache 
vomiting
seizures 
reduced vision
papilloedema
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4
Q

how does a transverse sinus thrombosis present

A

headache
mastoid pain
focal seizures
papilloedema

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5
Q

what structures pass through the cavernous sinus

A

CN 3, 4, 5 (1/2) and 6
internal carotid
sympathetic fibres

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6
Q

what is the most likely cause of cavernous sinus thrombosis

A

infection spread from the face

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7
Q

how does cavernous sinus thrombosis present

A 
ophthalmoplegia 
ptosis
fever
focal neurology
raised ICP
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8
Q

how is a sinus thrombosis managed

A

anticoagulation such as heparin, warfarin or streptokinase

manage symptoms of raised ICP

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9
Q

what does a subarachnoid haemorrhage bleed into

A

the subarachnoid space between the dura and pia mater

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10
Q

what is the most common cause of SAH and what conditions predispose to this

A

rupture of berry aneurysm

conditions such as PKD, Enhler Danlos and coarctation of the aorta predispose to this

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11
Q

other than rupture of berry aneurysm, what else causes SAH

A

arteriovenous malformation

vasculitis

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12
Q

bifurcation of cerebral arteries is a common site for which intracranial bleed

A

SAH

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13
Q

describe the headache felt in SAH

A

sudden onset, worst ever headache - thunderclap

can occur when lifting heavy objects or having sex

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14
Q

what are the other clinical features of SAH

A

collapse
decreased or loss of consciousness
meningism - photophobia and neck stiffness
3rd nerve palsy

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15
Q

what is the first line investigation for suspected SAH

A

CT but sensitivity reduces over time, shows grey areas within normally dark ventricles

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16
Q

what are the lumbar puncture findings of SAH

A

xanthochromic CSF - turns yellow due to breakdown of RBCs but takes at least 6 hours to develop

17
Q

what is the acute management of SAH

A

maintain cerebral perfusion by inducing hypertension with IV saline

18
Q

what drug can help with SAH and why

A

nimodipine, CCB that reduces the chance of cerebral artery spasm and ischaemia

19
Q

what is the surgical management for SAH

A

aneurysm clipping and repair

20
Q

what is the main complications of SAH

A

re-bleeding, often fatal
delayed ischaemia
hydrocephalus
hyponatraemia - manage with sodium supplements

21
Q

is a subdural haemorrhage venous or arterial blood

A

venous

22
Q

where does a subdural haemorrhage occur

A

in the bridging veins connecting the dural venous sinuses

blood accumulates between the dura and arachnoid mater

23
Q

what are the main risk factors for developing a subdural haemorrhage

A

increased age
alcoholism
epilepsy
anti-coags

24
Q

what events usually leads up to a subdural haemorrhage

A

usually in the context of low impact trauma that the individual sometimes cannot remember

25
Q

how does a subdural haemorrhage present

A 
fluctuations in consciousness 
sleepiness 
dull headache 
unsteadiness 
focal neurology 
onset of symptoms is slow and insidious
26
Q

what are the CT findings seen in a subdural haemorrhage

A

crescent/sickle shaped haematoma
not confined to the cranial suture lines
features of midline shift also seen

27
Q

how is a subdural haemorrhage managed

A

prophylactic anti-epileptics

surgery if expanding haematoma, burr hole craniotomy or craniotomy

28
Q

where does the bleed arise in an epidural haemorrhage

A

usually middle meningeal artery

29
Q

where does blood pool in an epidural haemorrhage

A

between the dura and the temporal bone

30
Q

a young person presenting with recent temporal bone fracture/trauma most likely has what

A

epidural haemorrhage

31
Q

how does an epidural haemorrhage present

A

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

32
Q

what are the CT findings of an epidural haematoma

A

lemon/lens/biconvex haemorrhage that is confined to cranial sutures

33
Q

how is an epidural haemorrhage managed

A

stabilise and transfer to neurosurgical unit for clot stabilisation and ligation of middle meningeal artery

Neurology (19 decks)

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