Intracranial haemorrhages Flashcards
What are the 2 categories
Spontaneous
Traumatic
Name the 3 spontaneous intracranial haemorrhages
Intracerebral haemorrhage
Subarachnoid haemorrhage
Haemorrhagic infarct
Name 5 traumatic intracranial haemorrhages / haematomas
Extra-dural haematoma Sub-dural haematom Contusion Intracerebral haemorrhage Sub-arachnoid haemorrhage
Subarachnoid haemorrhage - definition
Bleeding into the subarachnoid space
Subarachnoid haemorrhage - why does bleeding occur in the subarachnoid space?
This is where the major arterial supply of the brain is located
Subarachnoid haemorrhage - 2 categories of causes
Traumatic
Non-traumatic
Subarachnoid haemorrhage - traumatic causes are more common than non-traumatic causes. true or false?
True
Subarachnoid haemorrhage - give an example of a non-traumatic cause
Berry aneurysm rupture
- mostly occurs in the territory of the internal carotid artery
Where do berry aneurysms tend to form?
At the site where the arteries of the circle of willis branch
Subarachnoid haemorrhage - name 3 risk factors
Smoking
Hypertension
PKD (berry aneurysms)
Subarachnoid haemorrhage - more common in men/women
Women
Subarachnoid haemorrhage - most occur before/after the age of 50
before
Subarachnoid haemorrhage - onset
Abrupt
Sudden onset
Subarachnoid haemorrhage - clinical features
Sudden onset severe headache (thunderclap headache)
- headache takes less than 5 mins to reach its peak
Collapse
Vomiting
Neck pain
Photophobia
Subarachnoid haemorrhage - clinical signs
Neck stiffness Photophobia Global neurological deficit (decreased conscious level) Focal neurological deficit - Dysphasia, hemiparesis, CNIII palsy
Subarachnoid haemorrhage - which imaging investigation is first line?
CT scan
Which imaging investigation is usually accurate in picking up an acute bleed?
CT scan
What does fresh blood look like on a CT scan?
Highly dense -> looks white on CT scan
What does CSF look like on a CT scan
Black
If a CT scan identifies a subarachnoid haemorrhage then what is the next step?
There are no further investigations required
If a CT scan comes back negative then what is the next step?
Lumbar puncture
A lumbar puncture is safe to carry out after a normal CT scan. True or false?
True
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
Blood visible in CSF
Sometimes there are just blood breakdown products in the CSF that appear yellow
Why is it important to take 3 separate CSF samples when carrying out lumbar puncture?
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
What is the gold standard investigation to find a berry aneurysm?
Cerebral angiography
Subarachnoid haemorrhage - initial management
Mannitol - to lower ICP Bed rest Analgesia Anti-emetic IV fluids
Give 2 methods to treat aneurysms
Endovascular technique
- fill aneurysm with coils so that no more blood can get in
Surgical clipping
Subarachnoid haemorrhage - complications
Re-bleeding Delayed ischaemia Hydrocephalus Hyponatraemia Seizures
Benign coital cephalgia is related to ?
Having sex
Intracerebral haemorrhage - definition
Bleeding into the brain parenchyma
Intracerebral haemorrhage - causes
Secondary to hypertension
Aneurysm
Anticoagulation
Intracerebral haemorrhage - most common location
Basal ganglia
Intracerebral haemorrhage - morphology on cut surface of brain
Asymmetrical distortion of brain
Various shifts and herniations
Well demarcated intra-parenchymal haematomas
Surrounding oedema
Intracerebral haemorrhage - clinical features
Headache
Focal neurological deficit
Decreased conscious level
Intracerebral haemorrhage - first line investigation
CT scan
Intracerebral haemorrhage - mangement - indications for surgical management
If the patient has decreased conscious level
Intracerebral haemorrhage - indication for non-surgical management
Conscious
Intraventricular haemorrhage - definition
Blood in the ventricles
Extradural haemorrhage - location
Between the bone and dura
Which artery is located between the bone and dura and therefore must be ruptured in an extradural haemorrhage?
Middle meningeal artery
Extradural haemorrhage - occurs due tu rupture of ??
Pterion
Sub dural haemorrhage - definition
Collections of blood between the internal surface of the dura and arachnoid mater
What crosses the subarachnoid space between arachnoid and dura mater?
Cerebral veins
What is ruptured in a subdural haemorrhage ?
Cerebral veins
Sub dural haemorrhage - how does it occur?
Falls in the elderly
Alcoholics
Which type of haematoma is most common? intradural/extradural/subdural
Intradural
Extradural haematomas enlarge quickly/slowly?
Quickly
Acute subdural haematoma
Clear history of trauma
Swelling of cerebrum on side of haematoma
Acute subdural haematoma is common in young/elderly patients
Elderly
Elderly patient on anti platelet medication falls and there is minor head trauma. what is the likely diagnosis?
Subdural haematoma
Young man playing rugby and has a head strike. Initially loses consciousness -> lucid interval -> deterioration. What’s the likely diagnosis
Extradural haematology
