OnlineMedEd: Surgery: Subspecialty - Neuro Brain Bleeds

Question 1

Subarachnoid hemorrhages are generally produced by ________________.

Answer 1

aneurysms that burst under pressure

Question 2

What does “thunderclap headache” mean?

Answer 2

A headache that reaches its maximum intensity immediately

Question 3

What is the typical progression of symptoms for subarachnoid hemorrhage?

Answer 3

1) Headache with neck stiffness
2) Focal neurologic deficit
3) Coma

Question 4

If you suspect a subarachnoid hemorrhage, then order a _______________.

Answer 4

non-contrast CT of the head

Question 5

Where is the blood in a subarachnoid hemorrhage?

Answer 5

Between the brain and the arachnoid layer –not within the brain parenchyma

Question 6

How can you differentiate blood in the CSF that came from a traumatic LP as opposed to true xanthochromia?

Answer 6

Typically, a traumatic LP will cause bleeding in the first couple tubes of CSF but not in the last.

Question 7

What are the early complications of subarachnoid hemorrhage and how can you treat them?

Answer 7

• Within 48 hours after a SAH, you worry most about continued bleeding. Thus, you need to lower the patient’s BP to less than 140/90. If the bleeding is significant, then you may need to surgically intervene with coiling or clipping.
• Hydrocephalus is another complication within 48 hours. This can be treated with LPs or a VP shunt.

Question 8

As part of the treatment for late complications, all those who’ve had SAH need _____________ prophylaxis.

Answer 8

seizure

Generally, this is done with Keppra.

Question 9

List three things that are done to treat elevated ICP days after a subarachnoid hemorrhage.

Answer 9

• Elevate the head of the bed
• Give mannitol
• Hyperventilation

Question 10

Give nimodipine to treat _____________ after SAH.

Answer 10

vasospasm

Interestingly, increasing the BP can also treat vasospasm.

Question 11

The symptoms of ___________ are similar to those of subarachnoid hemorrhage: headache, nausea, vomiting, focal neurologic deficit, and coma.

Answer 11

intraparenchymal hemorrhage

Because these are also caused by hypertension, differentiating the two can be difficult!

Question 12

How can intraparenchymal hemorrhages be treated?

Answer 12

You mainly worry about the hematoma expanding and causing pressure injuries to the rest of the brain, so decreasing the ICP, craniotomies, or evacuation can be used.

Question 13

After a brain bleed, the patient needs daily ____________.

Answer 13

CTs to evaluate for hematoma expansion with midline shift