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Neurology SOH > Intracranial haemorrhages > Flashcards

Intracranial haemorrhages Flashcards

1
Q

What are the 2 categories

A

Spontaneous

Traumatic

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2
Q

Name the 3 spontaneous intracranial haemorrhages

A

Intracerebral haemorrhage
Subarachnoid haemorrhage
Haemorrhagic infarct

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3
Q

Name 5 traumatic intracranial haemorrhages / haematomas

A 
Extra-dural haematoma 
Sub-dural haematom
Contusion
Intracerebral haemorrhage 
Sub-arachnoid haemorrhage
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4
Q

Subarachnoid haemorrhage - definition

A

Bleeding into the subarachnoid space

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5
Q

Subarachnoid haemorrhage - why does bleeding occur in the subarachnoid space?

A

This is where the major arterial supply of the brain is located

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6
Q

Subarachnoid haemorrhage - 2 categories of causes

A

Traumatic

Non-traumatic

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7
Q

Subarachnoid haemorrhage - traumatic causes are more common than non-traumatic causes. true or false?

A

True

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8
Q

Subarachnoid haemorrhage - give an example of a non-traumatic cause

A

Berry aneurysm rupture

- mostly occurs in the territory of the internal carotid artery

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9
Q

Where do berry aneurysms tend to form?

A

At the site where the arteries of the circle of willis branch

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10
Q

Subarachnoid haemorrhage - name 3 risk factors

A

Smoking
Hypertension
PKD (berry aneurysms)

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11
Q

Subarachnoid haemorrhage - more common in men/women

A

Women

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12
Q

Subarachnoid haemorrhage - most occur before/after the age of 50

A

before

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13
Q

Subarachnoid haemorrhage - onset

A

Abrupt

Sudden onset

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14
Q

Subarachnoid haemorrhage - clinical features

A

Sudden onset severe headache (thunderclap headache)
- headache takes less than 5 mins to reach its peak

Collapse
Vomiting
Neck pain
Photophobia

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15
Q

Subarachnoid haemorrhage - clinical signs

A 
Neck stiffness
Photophobia
Global neurological deficit (decreased conscious level) 
Focal neurological deficit 
- Dysphasia, hemiparesis, CNIII palsy
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16
Q

Subarachnoid haemorrhage - which imaging investigation is first line?

A

CT scan

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17
Q

Which imaging investigation is usually accurate in picking up an acute bleed?

A

CT scan

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18
Q

What does fresh blood look like on a CT scan?

A

Highly dense -> looks white on CT scan

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19
Q

What does CSF look like on a CT scan

A

Black

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20
Q

If a CT scan identifies a subarachnoid haemorrhage then what is the next step?

A

There are no further investigations required

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21
Q

If a CT scan comes back negative then what is the next step?

A

Lumbar puncture

22
Q

A lumbar puncture is safe to carry out after a normal CT scan. True or false?

A

True

23
Q

If the patient has a -ve CT scan but gets a lumbar puncture, what features of LP suggest the patient has had a sub-arachnoid haemorrhage

A

Blood visible in CSF

Sometimes there are just blood breakdown products in the CSF that appear yellow

24
Q

Why is it important to take 3 separate CSF samples when carrying out lumbar puncture?

A

If bottle 1 has lots of blood but bottle 3 has much less blood, then this is a traumatic tap and is NOT a subarachnoid haemorrhage

25
Q

What is the gold standard investigation to find a berry aneurysm?

A

Cerebral angiography

26
Q

Subarachnoid haemorrhage - initial management

A 
Mannitol
- to lower ICP 
Bed rest 
Analgesia 
Anti-emetic 
IV fluids
27
Q

Give 2 methods to treat aneurysms

A

Endovascular technique
- fill aneurysm with coils so that no more blood can get in

Surgical clipping

28
Q

Subarachnoid haemorrhage - complications

A 
Re-bleeding 
Delayed ischaemia 
Hydrocephalus 
Hyponatraemia 
Seizures
29
Q

Benign coital cephalgia is related to ?

A

Having sex

30
Q

Intracerebral haemorrhage - definition

A

Bleeding into the brain parenchyma

31
Q

Intracerebral haemorrhage - causes

A

Secondary to hypertension
Aneurysm
Anticoagulation

32
Q

Intracerebral haemorrhage - most common location

A

Basal ganglia

33
Q

Intracerebral haemorrhage - morphology on cut surface of brain

A

Asymmetrical distortion of brain
Various shifts and herniations
Well demarcated intra-parenchymal haematomas
Surrounding oedema

34
Q

Intracerebral haemorrhage - clinical features

A

Headache
Focal neurological deficit
Decreased conscious level

35
Q

Intracerebral haemorrhage - first line investigation

A

CT scan

36
Q

Intracerebral haemorrhage - mangement - indications for surgical management

A

If the patient has decreased conscious level

37
Q

Intracerebral haemorrhage - indication for non-surgical management

A

Conscious

38
Q

Intraventricular haemorrhage - definition

A

Blood in the ventricles

39
Q

Extradural haemorrhage - location

A

Between the bone and dura

40
Q

Which artery is located between the bone and dura and therefore must be ruptured in an extradural haemorrhage?

A

Middle meningeal artery

41
Q

Extradural haemorrhage - occurs due tu rupture of ??

A

Pterion

42
Q

Sub dural haemorrhage - definition

A

Collections of blood between the internal surface of the dura and arachnoid mater

43
Q

What crosses the subarachnoid space between arachnoid and dura mater?

A

Cerebral veins

44
Q

What is ruptured in a subdural haemorrhage ?

A

Cerebral veins

45
Q

Sub dural haemorrhage - how does it occur?

A

Falls in the elderly

Alcoholics

46
Q

Which type of haematoma is most common? intradural/extradural/subdural

A

Intradural

47
Q

Extradural haematomas enlarge quickly/slowly?

A

Quickly

48
Q

Acute subdural haematoma

A

Clear history of trauma

Swelling of cerebrum on side of haematoma

49
Q

Acute subdural haematoma is common in young/elderly patients

A

Elderly

50
Q

Elderly patient on anti platelet medication falls and there is minor head trauma. what is the likely diagnosis?

A

Subdural haematoma

51
Q

Young man playing rugby and has a head strike. Initially loses consciousness -> lucid interval -> deterioration. What’s the likely diagnosis

A

Extradural haematology

Neurology SOH (31 decks)

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