Subarachnoid hemorrgae Flashcards
What is it?
Bleeding into the SA space (contains the CSF)
SA is between Pia and arachnoid
Aetiology
Cerebral ruptured aneurysm
Trauma
Presentation
Thunderclap headache
Sudden onset Occipital Usually during strenuous activity Neck stiffness Photophobia Weakness, seizure, speech
Risk factors
HBP Smoking alcohol cocaine FH Black Female 45-70
REALLY IMPORTANT RISK FACTORS
Use of cocaine
Sickle cell anaemia
CT disorders e.g. marfans
Neurofibromatosis
Investigations
CT head - may be normal or Hyperattenuation
LP: test CSF
Angiography: CT or MRI
Management
- Intubation and Ventilation
- Nimodopine- CCB- Vasospasm preventer- can lead to brain ischaemia following aneurysm
- Surgical intervention to repair the aneurysm
- Shunt used to reduce pressure
- Anti-epileptics to treat seizures
Surgical intervention
Coiling
- catheter into arterial system
- platinum coils which block off the aneurysm
Clipping
- put a clip on the aneurysm of the aneurysm to seal it
What do you see on CSF
(RCC raised)
Xanthocromia- yellow colour to blood- bilirubin
Complications
Vasospasm
Rebleed
Which brain bleed looks like eclipse?
Epidural
Which brain bleed is crescent shaped?
Subdural
Risk factors for brain bleeds
Head injury HBP Aneurysms Ischaemic stroke Brain tumours Anticoagulants- warfarin
Presentation of brain bleeds?
Seizures
focal weakness
vomiting
loss of consciousness
When do you need to worry about airway maintenance?
Less than 8 out 15 need to make sure you can maintain their airways
Eye movement
Spontaneous
In response to speech
In response to pain
No movement
Verbal response
Orientated Confused Inappropriate words Incomprehensible sounds No verbal response
Motor response
Obey commands Localise pain Normal flexion Abnormal flexion Extension of limbs No movement
Who gets subdurals?
More commonly in elderly patients and alcoholics as they have more atrophy in their brains
Extradural/ Epidural hemorrage aetiology
Middle meningeal artery in the temporal-parietal region
Between the skull and the dura mater
Have a bi-convex shape
Does not cross over the sutures
Extradural/ Epidural hemorrage aetiology
Middle meningeal artery rupture at the pterion.
It is found between the skull and the dura mater
Have a bi-convex shape
Does not cross over the sutures
Management of brain bleed
Immediate CT head FBC Clotting profile Specialist stroke centre Intubation, ventilation, ICU Assess with neurosurgeon whether they would do surgery
when is LP contraindicated!
Extradural
Intracerebral hemorragia
Bleed into the cerebral tissue
