Intracrianial Bleeds Flashcards
Risk factors for intracranial bleeds
Head injury Blood disorders - Haemophilia A or B HTN Aneurysms Ischaemic stroke - can progress to haemorrhage Brain tumours Anticoagulants - warfarin
General presentation of an intracranial bleed
Sudden onset headache Seizures Vomiting Reduced consciousness Sudden onset neurological symptoms
GCS
Eyes:
- spontaneous opening - 4
- speech - 3
- pain - 2
- none - 1
Verbal response:
- orientated - 5
- confused - 4
- inappropriate words - 3
- sounds - 2
- none - 1
Movement:
- obeys commands - 6
- moves towards pain - 5
- Moves away from pain - 4
- abnormal flexion - 3
- abnormal extension - 2
- none - 1
Cause of subdural haemorrhage
Rupture of bringing veins
Commonly in elderly and alcoholics due to brain atrophy causing strain on bridging veins
Bleeding in the subdural space between the dura and arachnoid layer
Shape of subdural haemorrhage on CT scan
Crescent shape as beyond suture lines
Cause of extradural haemorrhage
Head injury causing rupture of the middle meningeal artery
Bleeding between the skull and dura mater
Presentation of an extradural haemorrhage on CT
Bi concave shape like a lemon, confined to the suture lines
Presentation of extradural haemorrhage
Headache with lucid interval
Cause of subarachnoid haemorrhage
Cerebral aneurysm rupture in the circle of Willis
Bleeding between the arachnoid and pia mater in the subarachnoid space
Presentation of subarachnoid haemorrhage
Thunder clap headache Neck stiffness Photophobia Visual changes Neurological symptoms
Risk factors for subarachnoid haemorrhage
Cocaine use
Sickle cell anaemia
HTN
Family history
Associated with:
Connective tissue disorders such as Marfans or Ehlers Danlos syndrome
Neurofibromatosis
ADPCKD
Management of a cranial bleed
- Immediate CT
- Check FBC and clotting
- Admit to specialist stroke unit
- Discuss with surgery
- Consider intubation, ventilation and ICU care
- Correct clotting abnormality
- Correct severe HTN
Triggers for subarachnoid haemorrhage
Sudden increase in intracranial pressure such as lifting weights or intercourse
Who commonly gets subarachnoid haemorrhage
Female black women between the ages of 45 - 70 yo
Presentation of subarachnoid haemorrhage on CT scan
Hyperattenuation in the subarachnoid space
