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Sem 4 - Nervous System > Intracranial Haemorrhages > Flashcards

Intracranial Haemorrhages Flashcards

1
Q

What are the types of intracranial haemorrhages?

A

Extradural

Subdural

Subarachnoid

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2
Q

What is an extradural haemorrhage?

A

Collection of blood between the inner surface of the skull and the periosteal dura

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3
Q

What age group of patients are extradural haemorrhages more common in? Why?

A

Younger patients

Periosteal dura is more firmly adhered to skull in older patients

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5
Q

What causes an extradural haemorrhage?

A

Trauma, skull fracture

Gives rupture of an artery or tearing of a venous sinus

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6
Q

Which is more common in an extradural haemorrhage

  • rupture of an artery
  • tearing of venous sinus?
A

Rupture of an artery

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8
Q

How does an extradural haemorrhage relate to the tentorium cerebelli?

A

Usually above the tentorium cerebelli

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9
Q

What are the signs and symptoms of an extradural haemorrhage?

A

Loss of consciousness

Lucid interval

Deteriorating level of consciousness

Cranial nerve palsies

-these occur in order

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10
Q

What is the lucid interval, in a patient with an extradural haemorrhage?

A

Transient recovery, but with ongoing headache

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11
Q

What causes the initial loss of consciousness in a patient with extradural haemorrhage?

A

The injury itself

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12
Q

What causes the deteriorating level of consciousness in a patient with an extradural haemorrhage?

A

Haematoma enlarges, compression of brain

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13
Q

What causes cranial nerve palsies in a patient with an extradural haemorrhage?

A

Brain herniation

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14
Q

Why does an extradural haemorrhage have a short wide shape on a CT head scan?

A

Blood can’t pass the suture lines due to the periosteal dura adhering to the suture lines
Haematoma pushes inwards instead

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15
Q

What are the complications of an extradural haemorrhage?

A

Permanent brain damage

Coma

Seizures

Weakness

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16
Q

How is an extradural haemorrhage treated?

A

ABCDE approach

Small one is observed, managed conservatively, neurological follow up

Large one is treated by craniotomy, clot evacuation surgery

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17
Q

What is a subdural haemorrhage?

A

Collection of blood between the meningeal dura and the arachnoid

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18
Q

What causes subdural haemorrhages?

A

Rupture of bridging veins

Due to trauma or spontaneously

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19
Q

What does an extradural haemorrhage look like on a CT scan?

A

Hyperdense area, meaning whiter

Short and wide (lemon)

Midline shift

Lateral ventricles smaller or not visible

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20
Q

What are the types of subdural haemorrhage in terms of timing?

A

Acute, less than 3 days ago

Subacute, 3-21 days ago

Chronic, more than 3 weeks ago

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21
Q

What usually causes an acute subdural haemorrhage?

A

Head trauma

22
Q

What usually causes subacute or chronic subdural haemorrhages?

A

They occur spontaneously, in the elderly

23
Q

How do elderly patients with a subdural haemorrhage present?

A

Confusion and cognitive decline

24
Q

What does a subdural haemorrhage look like on a CT head scan?

A

Acute subdural haemorrhage - hyperdense

Subacute or chronic subdural haemorrhage - hypodense

Long narrow shape (crescent)

25
Q

Why is a subdural haemorrhage a long and narrow shape on a CT head scan?

A

Limited to one side of the head by the falx cerebri

26
Q

How are subdural haemorrhages treated?

A

Acute subdural haemorrhages by surgery

Subacute or chronic subdural haemorrhages by Burr Holes

27
Q

What is a Burr hole?

A

Incision in the skin, hole in the skull

28
Q

How do the outcomes of a subdural haemorrhage compare to an extradural haemorrhage?

A

Worse outcomes

29
Q

What is a subarachnoid haemorrhage?

A

Collection of blood between the arachnoid and the pia

30
Q

What age group are subarachnoid haemorrhages most common in?

A

Middle-aged patients

31
Q

What causes subarachnoid haemorrhage? Which is the most common cause?

A

Ruptured berry aneurysm, spontaneously ruptures - most common cause

Traumatic

32
Q

What are the signs and symptoms of a subarachnoid haemorrhage?

A

Sudden onset severe headache

Meningism

Nausea and vomiting

Fever

Focal neurological deficits

Loss of consciousness

33
Q

What is meningism?

A

Nuchal rigidity, neck stiffness

Photophobia, interolance of bright light

Headache

34
Q

Why does meningism occur with subarachnoid haemorrhage?

A

Irritation of meninges with blood

35
Q

What are the risk factors of a berry aneurysm?

A

Family history

Hypertension

Abnormal connective tissue e.g. Ehler’s Danlos, Marfan’s syndrome

36
Q

Where do berry aneurysms occur, from most common to least common?

A

Anterior circulation

  • anterior cerebral artery
  • proximal middle cerebral artery
  • distal middle cerebral artery

Posterior circulation

In each artery, particularly at bifurcations

37
Q

Why do berry aneurysms particularly occur at bifurcations of arteries?

A

Rapid change in direction of blood flow
Turbulent blood flow
Damage to blood vessel wall

38
Q

What are the signs and symptoms of a berry aneurysm?

A

Asymptomatic

Symptoms due to compression of nearby structures

39
Q

What does a berry aneurysm look like on a CT head scan?

A

Focal hyperdense area, may enter ventricular system

40
Q

How is a subarachnoid haemorrhage diagnosed?

A

Lumbar puncture

  • presence of red blood vessels
  • xanthochromia within 12 hours
41
Q

What is xanthochromia?

A

Yellow discolouration indicating presence of bilirubin in CSF

42
Q

How is a subarachnoid haemorrhage treated?

A

Prevent rebleeding

Treat cerebral vasospasm

Correct hyponatraemia

Surgery if large bleed

43
Q

What are the complications of a subarachnoid haemorrhage?

A

Hydrocephalus

Focal neurological deficits

Coma

Seizures

Cognitive decline

Frequent headaches

Hypopituitarism

44
Q

How is a berry aneurysm treated?

A

Surgical clipping

Endovascular coiling

45
Q

What is endovascular coiling?

A

Metal wires inserted into aneurysm till no blood flow occurring in it

46
Q

What age group are subdural haemorrhages most common in? Why?

A

Older age group

Brain has atrophied, more tension on bridging veins, more likely to rupture

47
Q

Which artery is most commonly ruptured in an extradural haemorrhage?

A

Middle meningeal artery

Sem 4 - Nervous System (25 decks)

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