Intracranial Haemorrhages Flashcards
What are the types of intracranial haemorrhages?
Extradural
Subdural
Subarachnoid
What is an extradural haemorrhage?
Collection of blood between the inner surface of the skull and the periosteal dura
What age group of patients are extradural haemorrhages more common in? Why?
Younger patients
Periosteal dura is more firmly adhered to skull in older patients
What causes an extradural haemorrhage?
Trauma, skull fracture
Gives rupture of an artery or tearing of a venous sinus
Which is more common in an extradural haemorrhage
- rupture of an artery
- tearing of venous sinus?
Rupture of an artery
How does an extradural haemorrhage relate to the tentorium cerebelli?
Usually above the tentorium cerebelli
What are the signs and symptoms of an extradural haemorrhage?
Loss of consciousness
Lucid interval
Deteriorating level of consciousness
Cranial nerve palsies
-these occur in order
What is the lucid interval, in a patient with an extradural haemorrhage?
Transient recovery, but with ongoing headache
What causes the initial loss of consciousness in a patient with extradural haemorrhage?
The injury itself
What causes the deteriorating level of consciousness in a patient with an extradural haemorrhage?
Haematoma enlarges, compression of brain
What causes cranial nerve palsies in a patient with an extradural haemorrhage?
Brain herniation
Why does an extradural haemorrhage have a short wide shape on a CT head scan?
Blood can’t pass the suture lines due to the periosteal dura adhering to the suture lines
Haematoma pushes inwards instead
What are the complications of an extradural haemorrhage?
Permanent brain damage
Coma
Seizures
Weakness
How is an extradural haemorrhage treated?
ABCDE approach
Small one is observed, managed conservatively, neurological follow up
Large one is treated by craniotomy, clot evacuation surgery
What is a subdural haemorrhage?
Collection of blood between the meningeal dura and the arachnoid
What causes subdural haemorrhages?
Rupture of bridging veins
Due to trauma or spontaneously
What does an extradural haemorrhage look like on a CT scan?
Hyperdense area, meaning whiter
Short and wide (lemon)
Midline shift
Lateral ventricles smaller or not visible
What are the types of subdural haemorrhage in terms of timing?
Acute, less than 3 days ago
Subacute, 3-21 days ago
Chronic, more than 3 weeks ago
What usually causes an acute subdural haemorrhage?
Head trauma
What usually causes subacute or chronic subdural haemorrhages?
They occur spontaneously, in the elderly
How do elderly patients with a subdural haemorrhage present?
Confusion and cognitive decline
What does a subdural haemorrhage look like on a CT head scan?
Acute subdural haemorrhage - hyperdense
Subacute or chronic subdural haemorrhage - hypodense
Long narrow shape (crescent)
Why is a subdural haemorrhage a long and narrow shape on a CT head scan?
Limited to one side of the head by the falx cerebri
How are subdural haemorrhages treated?
Acute subdural haemorrhages by surgery
Subacute or chronic subdural haemorrhages by Burr Holes
What is a Burr hole?
Incision in the skin, hole in the skull
How do the outcomes of a subdural haemorrhage compare to an extradural haemorrhage?
Worse outcomes
What is a subarachnoid haemorrhage?
Collection of blood between the arachnoid and the pia
What age group are subarachnoid haemorrhages most common in?
Middle-aged patients
What causes subarachnoid haemorrhage? Which is the most common cause?
Ruptured berry aneurysm, spontaneously ruptures - most common cause
Traumatic
What are the signs and symptoms of a subarachnoid haemorrhage?
Sudden onset severe headache
Meningism
Nausea and vomiting
Fever
Focal neurological deficits
Loss of consciousness
What is meningism?
Nuchal rigidity, neck stiffness
Photophobia, interolance of bright light
Headache
Why does meningism occur with subarachnoid haemorrhage?
Irritation of meninges with blood
What are the risk factors of a berry aneurysm?
Family history
Hypertension
Abnormal connective tissue e.g. Ehler’s Danlos, Marfan’s syndrome
Where do berry aneurysms occur, from most common to least common?
Anterior circulation
- anterior cerebral artery
- proximal middle cerebral artery
- distal middle cerebral artery
Posterior circulation
In each artery, particularly at bifurcations
Why do berry aneurysms particularly occur at bifurcations of arteries?
Rapid change in direction of blood flow
Turbulent blood flow
Damage to blood vessel wall
What are the signs and symptoms of a berry aneurysm?
Asymptomatic
Symptoms due to compression of nearby structures
What does a berry aneurysm look like on a CT head scan?
Focal hyperdense area, may enter ventricular system
How is a subarachnoid haemorrhage diagnosed?
Lumbar puncture
- presence of red blood vessels
- xanthochromia within 12 hours
What is xanthochromia?
Yellow discolouration indicating presence of bilirubin in CSF
How is a subarachnoid haemorrhage treated?
Prevent rebleeding
Treat cerebral vasospasm
Correct hyponatraemia
Surgery if large bleed
What are the complications of a subarachnoid haemorrhage?
Hydrocephalus
Focal neurological deficits
Coma
Seizures
Cognitive decline
Frequent headaches
Hypopituitarism
How is a berry aneurysm treated?
Surgical clipping
Endovascular coiling
What is endovascular coiling?
Metal wires inserted into aneurysm till no blood flow occurring in it
What age group are subdural haemorrhages most common in? Why?
Older age group
Brain has atrophied, more tension on bridging veins, more likely to rupture
Which artery is most commonly ruptured in an extradural haemorrhage?
Middle meningeal artery
