Subarachnoid, Extradural, Subdural Haemorrhage ☺️

Question 1

Risk factors leading to SAH

Answer 1

Traumatic SAH
Spontaneous SAH
-berry aneurysm
-AVM

Question 2

Presentation of SAH
Confirmation
Investgations

Answer 2

Thunderclap occipital headache
N+V
Meningism (photophobia, neck stiffness)
Coma

CT without contrast => hyper dense flooding of basal cistern (star shape)

If history +ve but CT -ve => lumbar puncture for RBC breakdown products 12hrs after, raised opening pressure

REFER TO NEUROSURGERY ONCE CONFIRMED
-Cerebral angiogram

Question 3

SAH management

• definitive
• reduce complications

Answer 3

1. Coil or clip aneurysm => prevent rebleeding
2. Nimodipine, maintain circulatory volume => prevent delayed cerebral ischemia due to vasospasm
3. Hydrocephalus => ventricular drain
4. Seizure management - phenytoin

Question 4

Risk factors for extradural haemorrhage

Answer 4

Collection of blood between endosteal layer of dura and skull
-MMA often affected

Head trauma

Question 5

Presentation of extradural hematoma

Investigations

Answer 5

Raised ICP

• headache
• vomiting
• reduced consciousness
• papilloedema
• Cushing’s triad (widening pulse pressure, bradycardia, irregular breathing)

Lucid period

CT no contrast => lenticular biconvex hyperdense, limited by suture lines

ICP monitoring

Question 6

Management of EDH/SDH

• definitive
• supportive

Answer 6

Supportive

• Correct coagulation
• Prophylactic ABx for open fractures
• Phenytoin - reduce seizures

Reduce ICP
-mannitol, barbiturates

Definitive

• Small - watch and wait
• Neurological deficit/severe - burr holes, craniotomy

Question 7

Differences between

• acute SDH
• chronic SDH

Answer 7

Risk factors

• old age
• alcohol
• anticoagulation

Acute SDH - trauma
-CT - hyperdense blood

Chronic SDH - minor head injury tearing weakned bridging veins
-CT- hypodense blood

Both are

• crescenteric
• not restricted by sutures
• mass effect
• slow onset of symptoms than epidural
• fluctuating confusion/consciousness