Intracranial hemorrhage

Question 1

Extradural haemorrhage: location

Answer 1

Between the skull and dura mater of the meninges. Commonly caused by trauma to the pterion, with subsequent tearing of the middle meningeal artery

Question 2

Extradural haemorrhage: features

Answer 2

typically caused by a clearly defined head trauma in young patients following a head strike

acute severe headache, contralateral hemiplegia, and a rapid deterioration in GCS following a LUCID PERIOD

Question 3

Extradural haemorrhage: DOES IT CROSS SUTURES

Answer 3

No –> sutures are where dura meets skull

Question 4

Extradural CT

Answer 4

Biconvex max
CHECK FOR MASS EFFECT (midline shift or uncal herniation)

Question 5

Subdural haemorrhage: location

Answer 5

venous blood accumulating in the potential space between the dura mater and arachnoid mater

Question 6

Subdural haemorrhage: aetiology

Answer 6

typically occurs in elderly patients following minor trauma, resulting in shearing forces that tear bridging veins between the cortex and dura mater.

Question 6

Subdural RFs

Answer 6

Advancing age (>65 years old)
Bleeding disorders or anticoagulant therapy
Chronic alcohol use, and
Recent trauma.

Question 7

Subdural features

Answer 7

Headache, nausea or vomiting, confusion, and diminished eye/verbal/motor response.

There may be focal neurological signs indicative of the haematoma site.

Question 8

Subdural CT

Answer 8

crescent-shaped homogeneously hyperdense extra-axial collection over the affected hemisphere.

CROSSES SUTURE LINES

Becomes hypodense as time goes by

Question 9

SAH RFs

Answer 9

80% will be found to have a ruptured berry aneurysm.

Hypertension
Adult polycystic kidney disease
Alcohol excess
Smoking

Question 10

SAH Features

Answer 10

Sudden onset severe headache typically described as the worst headache of the patients life. Clues in the history include physical exertion or coitus prior to onset.

Meningism (eg neck rigidity)
retinal haemorrhages

Question 11

SAH invx

Answer 11

CT head

If unreliable –> LP (only after 12hrs will xanthochromia show)

Question 12

SAH mx

Answer 12

Medical
- Nimodipine (in critical care)

Radiological & surgical
- Endovascular techniques exist for coiling or stenting SAH bleed.
Surgical techniques include clipping.

Question 13

SAH prognosis

Answer 13

Mortality from SAH approached 50%

If GCS>14 at hospital, >90% survive