[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
what are the CT findings in extradural haematoma?
hyperdense biconvex (lentiform) collection; does not cross suture lines
how does a subdural haematoma present?
acute vs chronic presentation
what is the vessel involved in a subdural haematoma?
bridging dural veins
what are the CT findings in subdural haematoma?
cresenteric collection; crosses suture lines
how does an intracerebral haemorrhage present?
- haemorrhagic stroke
- hemiplegia / visual field defects
- HTN risk factor
what are the vessels involved in an intracerebral haemorrhage?
intracerebral vessels
what are the CT findings in an intracerebral haemorrhage?
hyperdensity within substance of the brain
HTN, bradycardia, Kussmaul breathing. dx?
Cushing’s triad of raised ICP
fall in elderly pt on warfarin. dx?
acute subdural, consider prothrombin complex if INR raised
high suspicion of SAH but normal CT. what do you do next?
LP at 12 hours for xanthochromia
