[Neuro] Intracranial Haemorrhage Flashcards
what can a traumatic subdural haematoma be classified into?
(dependent on time onset)
- acute
- subacute
- chronic
what is an acute subdural haematoma and what are the CT findings?
1-2 days
hyperdense cresenteric collection
+/- mass effect / midline shift
what are the features of acute subdural haematoma?
- reduced GCS/coma immediately from event
- major trauma
- raised ICP signs
what is a subacute subdural haematoma and what are the CT findings?
3-14 days
isodense cresenteric collection
what is a chronic subdural haematoma and what are the CT findings?
> 15 days
hypodense cresenteric collection
what are the features of chronic subdural haematoma?
- insidious onset headache
- minor trauma
- anticoagulation
- elderly +/- falls
- reduced GCS / confusion develops as time goes on
how do you manage acute subdural haematoma?
surgery (Burr hole / decompression / craniectomy)
indications:
- clot thickness ≥ 10mm
- midline shift ≥ 5mm
- GCS drop ≥ 2 since injury / hospital admission
- signs of raised ICP
how do you manage chronic subdural haematoma?
indications for surgery:
- signs of raised ICP
- moderate-severe cognitive impairment due to haematoma in pts with potential for recovery
what are the signs of raised ICP?
- asymmetrical pupils
- cranial nerve palsies
- Cushing’s triad
what is the Cushing’s triad?
- HTN
- bradycardia
- Kussmaul breathing
how does a subarachnoid haemorrhage (SAH) present?
- thunderclap, occipital headache with meningism
- severe HTN
- associated with ADPKD
what is the vessel involved in SAH?
ruptured cerebral aneurysm
what are the CT findings in SAH?
hyperdensity within the cisterns/sulci
how does an extradural haematoma present?
- major trauma (over pterion)
- lucid period followed by rapid decline in GCS
- mass effect / raised ICP
what is the vessel involved in extradural haematoma?
middle meningeal artery
