Intracranial Haemorrhages Flashcards
An Epi/extradural haemorrhages occurs between X and Y
What is X and Y
Between the skull and dura
A midline shift is most associated with what intracranial haemorrhage?
Subdural haemorrhage
Which intracranial haemorrhage is most associated with CN 3 palsy? What signs and symptoms would this cause?
Epidural haemorrhage
Which intracranial haemorrhage is most associated with venous bleeding?
Subdural
What is the typical mechanism of injury for an epidural haematoma?
What artery is typically affected?
What are Sx of an epidural haemorrhage?
Specific: Lucid interval
For any SOL:
Sx of raised ICP:
1) Altered conciousness (GCS, confusion +/- Coma)
2) headache worse when lying flat/in morning),
3) N+V,
4) Blurred vision + Diplopia
5) Coma
6) Dizziness and light headedness (syncope but not syncope?)
Herniation/brainstem involvement =>
1) Cushing’s Triad: HTN, Bradycardia, Irregular resp (e.g. Cheyne Stokes breathing)
2) Cardio-resp compromise
3) CN palsies
4) Focal Neurological deficits
What is Cheyne-Stokes Respiration
abnormal irregular breathing which occurs in brain injury, raised ICP and heart failure. It is characterised by gradually increasing and decreasing tidal volumes (depth of resp clinically) followed by a period of apnoea
You perform a non-contrast CT brain following a patient presenting with a blow to the pterion at a pub. What findings will you be looking for?
1) Biconvex/Lentiform Hyperattenuation
2) Ventricular Compression
3) Midline shift
What gives an epidural haematoma its lentiform distribution?
Due to the strong adherence between the dura and the skull, the bleeding does not cross sutures
What is the management of an epidural haematoma?
A Subdural haemorrhages occurs between X and Y
What is X and Y
Between Dura and Arachnoid
What is the mechanism of injury for a subdural haematoma?
What are the top 4 RF of subdural haemorrhage?
1) Elderly
2) Anticoagulation
3) Alcoholic
4) Anything impairing conciousness, cognition, or stability => increasing risk of fall (e.g. benzodiazepines, alzheimer’s, parkinson’s, orthostatic hypotension, amputation…..)
What is the clinical presentation of an acute Subdural haematoma?
For any SOL:
Sx of raised ICP:
1) Altered conciousness (GCS, confusion +/- Coma)
2) headache worse when lying flat/in morning),
3) N+V,
4) Blurred vision + Diplopia
5) Coma
6) Dizziness and light headedness (syncope but not syncope?)
Herniation/brainstem involvement =>
1) Cushing’s Triad: HTN, Bradycardia, Irregular resp (e.g. Cheyne Stokes breathing)
2) Cardio-resp compromise
3) CN palsies
4) Focal Neurological deficits
What is the clinical presentation of a chronic Subdural haematoma?
Insidious, progressive neurological deficits (congition or focal)
You perform a Non-contrast CT of an elderly patient on anticoagulants presenting with a head injury. They also have a significant alcohol history. What findings would you be looking for to be consistent with this presentation?
How would you differentiate between acute and chronic?
This is a case of Subdural haemorrhage (most likely)
How would you manage a subdural haemorrhage?
Acute = Same as epidural = decompressive craniotomy within 2 hours + haemostasis and diathermy of bleeding vessels
