Neurology - intracranial bleeds Flashcards
Risk factors for intracranial bleeds
Head injury Hypertension Aneurysms Ischaemic stroke can progress to haemorrhage Brain tumours Anticoagulants such as warfarin
How do intracranial bleed present?
Sudden onset headache is a key feature
Also with:
- Seizures
- Weakness
- Vomiting
- Reduced consciousness
- Other sudden onset neurological symptoms
What causes subdural haemorrhage?
Rupture of the bridging veins in the dura
Occur more frequently in elderly or alcoholic patients - These patients have more atrophy in their brains making vessels more likely to rupture.
What causes extradural haemorrhage?
Rupture of the middle meningeal artery in the temporo-parietal region
Can be associated with trauma e.g. fractured temporal bone
Typical presentation of extradural haemorrhage
Traumatic injury with ongoing headache
Rupture of the middle meningeal artery in the temporo-parietal region
Presentation of an intracerebral haemorrhage? What causes them?
Similarly to an ischaemic stroke
They can occur spontaneously or as the result of bleeding into an ischaemic infarct or tumour or rupture of an aneurysm.
What causes subarachnoid haemorrhage?
Usually due to ruptured aneurysm
Typical presentation of subarachnoid haemorrhage
The typical history is a sudden onset occipital headache that occurs during strenuous activity such as weight lifting or sex.
What are subarachnoid haemorrhages also associated with?
Cocaine use
Sickle cell anaemia
Principles of management of intracranial bleeds…
Immediate CT head to establish the diagnosis
Check FBC and clotting
Admit to a specialist stroke unit
Discuss with a specialist neurosurgical centre to consider surgical treatment
Consider intubation, ventilation and ICU care if they have reduced consciousness
Correct any clotting abnormality
Correct severe hypertension but avoid hypotension (hypotension may mean the brain becomes ischaemic)
CT head findings in subdural vs extradural
Subdural - crescent shape, not limited by cranial sutures
Extradural - bi-convex shape and limited by cranial sutures
What can be given in raised ICP which is life threatening e.g. in extradural awaiting theatre?
IV mannitol or furosemide
