Lecture 5- Intracranial haemorrhage

Question 1

intracranial haemorrhage

Answer 1

Head trauma can lead to bleeding in spaces between meningeal layers

Question 2

Blood vessels run…

Answer 2

along or transevrse between meningeal layers

Question 3

Injury and bleeding from these blood vessels will cause

Answer 3

accumulation of blood in the space between the meningeal layers

Question 4

types of intracranial haemorrhages

Answer 4

• Extradural
• Subdural
• Subarachnoid

Question 5

intracerebral haemorrhage

Answer 5

• Bleeding can also occur within the brain tissue itself e.g. contusions, tearing of white matter

Question 6

why are intracranial haemorrhages dangerous

Answer 6

• Addition of volume to an already fixed space (the skull) leads to rise in pressure and damage to brain tissue, brainstem and other important structures e.g. cranial nerves

Question 7

extra dural haemorrhage occurs in the …

Answer 7

a collection of blood in the ‘potential’ space between the skull and the dura mater

Question 8

extradural haemorrhage usually occurs because of

Answer 8

head injury

It is a serious condition and emergency treatment is needed. An operation to remove the haematoma may be needed.

Question 9

what does extradural haemorrhage look on the CT scan

Answer 9

• biconvex shape of bleed (right hand picture)
• strips periosteal layer away from the bone (inner table)

Question 10

signs and symptoms of extradural haemorrhage

Answer 10

• Lucid interval characteristic of extradural haemorrhage
• when someone passes out, wakes and seems lucid and then deteriorate very quickly
• Headache
• After head injury

Question 11

subdural haemorrhage

Answer 11

venous bleed- fills subdural spaces

A type of bleeding in which a collection of blood—usually associated with a traumatic brain injury—gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. It usually results from tears in bridging veinsthat cross the subdural space.

Question 12

Subdural hematomas may cause an

Answer 12

increase in the pressure inside the skull, which in turn can cause compression of and damage to delicate brain tissue.

Question 13

acute vs chronic subdural haematomas

Answer 13

Acute subdural hematomas are often life-threatening. Chronic subdural hematomas have a better prognosis if properly managed.

Question 14

subarachnoid haemorrhage

Answer 14

arterial bleed - usually a branch of the circle of willis (arterial circuit responsbible for supplying brain structures)

• in the subarachnoid space- mixing with CSF- sudden, often fatal

Question 15

testing for subarachnoid haemorrhage

Answer 15

• CT imaging of head
  
  • 93% picked up if within 24 hours
  • 100% if within 6 hours
  • Lumbar puncture if CT inconclusive: sample CSF to identify presence of blood (GHb degradation products)

Question 16

summary

Answer 16

• Three meningeal layers that confer support and protection for brain
  
  • – Spaces or potential spaces between layers exist where blood can accumulate if

head trauma occurs

• – Extradural, subdural and subarachnoid haemorrhage
• Dura consists of ‘two-layers’ closely adhered to each other but separate in key areas to form
  
  • – Dural folds
  • – Dural venous sinuses- full of venous blood
• Cerebral veins draining the brain enter into dural venous sinuses (bridging veins traverse the space between dura and arachnoid)
• Venous dural sinuses ultimately join and drain towards the internal jugular vein