Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Week 22 - Raised intercranial pressure, sub arach haemmorhage, subdural haematoma, vasovagal, tension headache > Flashcards

Week 22 - Raised intercranial pressure, sub arach haemmorhage, subdural haematoma, vasovagal, tension headache Flashcards

1
Q

how does one test for raised intracranial pressure

A

imaging - a CT of the head or MRI can reveal signs of raised ICP,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the signs on imaging of raised ICP

A

enlarged ventricles
herniation
or mass effect from causes such as tumours, abscesses, haemoatomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what can you used to measure the pressure of the CSF

A

a lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what do subarachnoid haemorrhages involve

A

bleeding into the subarachnoid space, where the CSF fluid is located, between the pia mater and the arachnoid membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is subarachnoid haemorrhage usually a result of

A

ruptured cerebral aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

subarachnoid haemorrhages are most common in who

A

aged 45-70
women
black ethnic origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the general risk factors for subarachnoid haemorrhage

A

hypertension
smoking
excessive alcohol intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is subarachnoid haemorrhage particularly associated with

A

Family history
Cocaine use
Sickle cell anaemia
Connective tissue disorders (e.g., Marfan syndrome or Ehlers-Danlos syndrome)
Neurofibromatosis
Autosomal dominant polycystic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the typical history of a subarachnoid haemorrhage

A

sudden-onset occipital headache during strenuous activity, such as heavy lifting or sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does the sudden and severe onset of activity lead to in subarachnoid haemorrhage

A

thunderclap headache description - may feel like being struck over the back of the head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are other important features of subarachnoid haemorrhage presentation

A

Neck stiffness
Photophobia
Vomiting
Neurological symptoms (e.g., visual changes, dysphasia, focal weakness, seizures and reduced consciousness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the first line investigation for subarachnoid haemorrhage

A

CT head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what will be seen on a CT head with a subarachnoid

A

blood will cause hyper-attenuation in the subarachnoid space. however, a normal CT does not exclude a subarachnoid haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is considered after a normal CT in the case of suspected Sub Arach

A

lumber puncture

NICE recommends waiting at least 12 hours after the symptoms start before performing a lumbar puncture, as it takes time for the bilirubin to accumulate in the CSF.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what will a CSF sample show in the case of a sub arach

A

raised RBC - a decreasing red cell count on successive bottles may be due to a traumatic procedure

Xanthochromia - a yellow colour to the CSF caused by bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is used after confirming the diagnosis of a sub arach

A

CT angiogrpahy is used to locate the source of the bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what may be used to treat aneurysms

A

surgical intervention - this aims to repair the vessel and prevent re-bleeding.

this can be done by endovascular coiling, which involves inserting a catheter into the arterial system, placing platinum coils in the aneurysm and sealing it off from the artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is used to prevent vasospasm - a common complication of sub arachs

A

nimodipine is a CCB used to prevent vasospasm

vasospasm resulting in brain ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the treatment options for hydrocephalus in sub arachs

A

Lumbar puncture
External ventricular drain (a drain inserted into the brain ventricles to drain CSF)
Ventriculoperitoneal (VP) shunt (a catheter connecting the ventricles with the peritoneal cavity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the four types of intracranial haemorrhage

A

Extradural haemorrhage (bleeding between the skull and dura mater)

Subdural haemorrhage (bleeding between the dura mater and arachnoid mater)

Intracerebral haemorrhage (bleeding into brain tissue)

Subarachnoid haemorrhage (bleeding in the subarachnoid space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the risk factors for intracranial bleeds

A

Head injuries
Hypertension
Aneurysms
Ischaemic strokes (progressing to bleeding)
Brain tumours
Thrombocytopenia (low platelets)
Bleeding disorders (e.g., haemophilia)
Anticoagulants (e.g., DOACs or warfarin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the presentation of a intracranial bleed

A

Sudden-onset headache is a key feature. They can also present with:

Seizures
Vomiting
Reduced consciousness
Focal neurological symptoms (e.g., weakness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the minimum score on GCS

A

3/15

24
Q

where does an extradural haematoma occur

A

between the skull and dura mater

25
Q

what is an extradural haemorrhage usually caused by

A

a rupture of the MMA in the temporoparietal region

26
Q

what is an extradural haemorrhage associated with

A

a fracture of the temporal bone

27
Q

what is seen on a CT scan in the case of an extradural haemorrhage

A

they have a bi-convex shape and are limited by the cranial sutures (they do not cross the sutures, which are the points where the skull bones join together)

28
Q

where does a subdural haemorrhage occur between and what causes it

A

the dura mater and the arachnoid mater and is caused by a rupture of the bridging veins in the outermost meningeal layer

29
Q

what is seen on a CT of a subdural haemorrhage

A

they have a cresent shape and are not limited by the cranial sutures

30
Q

who do subdural haemorrhages occur mostly in

A

the elderly and alcoholic patients, who have more atrophy in their brains, making the vessels more prone to rupture

31
Q

what does intracerebral haemorrhage involve

A

bleeding in the brain tissue

32
Q

how does an intracerebral haemorrhage present

A

similarly to an ischaemic stroke with sudden onset focal neurological symptoms, such as limb or facial weakness, dysphasia or vision loss

33
Q

how do intracerebral haemorrhages occur

A

occur spontaneously or secondary to ischaemic stroke, tumours or aneurysm rupyure

34
Q

what does a subarachnoid haemorrhage involve

A

bleeding in the subarachnoid space where the CSF is located, between the pia mater and the arachnoid mater.

35
Q

what is a subarachnoid haemorrhage usually the result of

A

a ruptured cerebral aneurysm

36
Q

what is the typical history/presentation of a subarachnoid haemorrhage

A

sudden onset occipital headache during strenuous activity, such as heavy lifting or sex. the sudden and sever eonset leads to ‘thunderclap headache’

37
Q

what is required immediately in the management of a potential brain bleed

A

CT head is required to establish a diagnosis

38
Q

what does initial management for an intracranial bleed involve

A

Admission to a specialist stroke centre
Discuss with a specialist neurosurgical centre to consider surgical treatment
Consider intubation, ventilation and intensive care if they have reduced consciousness
Correct any clotting abnormality (e.g., platelet transfusions or vitamin K for warfarin)
Correct severe hypertension but avoid hypotension

39
Q

what are the surgical options for treating an extradural or subdural haematoma

A

craniotomy (open surgery by removing a section of the skull)

burr holes (small holes drilled into the skull to drain the blood)

40
Q

what percentage of all headaches do tension headaches account for

A

40% of all headaches

41
Q

how long do tension headaches last for and how often are they

A

they typically last for several hours, and often recur daily

42
Q

are symptoms of a tension headache uni or bi lateral

A

bilateral

43
Q

how do patients describe a tension headache

A

tight band sensation, pressure behind the eyes,

can be across the whole top of the head, typically frontal with or without radiation to the occiput

44
Q

do tension headaches wake patients from their sleep

A

do not wake patients from their sleep - typically onset is after waking, often worse during the middle of the day

45
Q

are tension headaches sensitive to head movement and is there a feeling of needing to vomit

A

not sensitive to head movement

no feeling of need to vomit

generally no neurological signs

46
Q

does alcohol make a tension headache better or worse

A

better

47
Q

what are the causes of tension headaches

A

stress
noise
concentrated visual effort
fumes/smells

48
Q

how is tension headache diagnosed

A

using the International Headache Society Criteria

49
Q

what does the International Headache Society criteria state

A

At least x10 episodes of similar headache
Head duration 30 min – 7 days
At least two of:
Non-pulsating
Mild or moderate intensity
Bilateral
Not aggravated by routine activity
Must have both of:
No nausea or vomiting
No photophobia or phonophobia (or only one of these)
Not attributable to another disorder

50
Q

in chronic tension headache, how often should one take analgesia

A

limit analgesia to 2-3 days per week

51
Q

what is a vasovagal episode caused by

A

caused by a problem with the autonomic nervous system regulating blood flow to the brain.

52
Q

what happens when the vagal nerve receives a strong stimulus, such as an emotional event, temperature or pain

A

it can stimulate the parasympathetic nervous system. Parasympathetic activation counteracts the sympathetic nervous system, which keeps the smooth muscles in blood vessels constricted. As the blood vessels delivering blood to the brain relax, the blood pressure in the cerebral circulation drops, leading to hypoperfusion of brain tissue. This causes the patient to lose consciousness and “faint”.

53
Q

how do patients usually feel before a vasovagal episode

A

Hot or clammy
Sweaty
Heavy
Dizzy or lightheaded
Vision going blurry or dark
Headache

54
Q

how would an outsider describe a patient who had a vasovagal episode

A

Suddenly losing consciousness and falling to the ground
Unconscious on the ground for a few seconds to a minute as blood returns to their brain
There may be some twitching, shaking or convulsion activity, which can be confused with a seizure

55
Q
A

Year 3 (63 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions