Intracranial Haemorrhage Flashcards Preview

Neurology > Intracranial Haemorrhage > Flashcards

Flashcards in Intracranial Haemorrhage Deck (33)
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1
Q

3 types of spontaneous intracranial haemorrhage?

A

subarachnoid
intracerebral
intraventricular

2
Q

what usually causes subarachnoid haemorrhage?

A
berry aneurysm (usually in the circle of willis at the base of the brain in the CSF)
sometimes AVM or no underlying cause
3
Q

how does subarachnoid haemorrhage present?

A
very sudden severe onset persistent explosive headache (thunderclap, like being hit with a bat)
collapse
vomiting
neck pain
photophobia
- meningitis symptoms
4
Q

benign coital cephalgia?

A

sudden onset severe headache during sex

5
Q

what are the signs of SAH?

A

meningitic - neck stiffness, photophobia
can have decreased conscious level
can have focal neurological deficit (CN III palsy, dysphasia, hemiparesis etc)
retinal or vitreous haemorrhage on fundoscopy

6
Q

how is SAH diagnosed?

A

CT

  • can be negative if >3 days since onset
  • 15% false negative
7
Q

CSF vs blood on imaging?

A
CSF = low density = black
blood = high density = white
8
Q

what is seen on CT in SAH?

A

white areas around the base of the brain

often in shape of circle of willis in the middle

9
Q

what is done if CT is negative but SAH is suspected?

A

lumbar puncture

- shows bloodstained or xanthochromic (yellow) CSF from 6-48 hrs

10
Q

when is lumbar puncture done in suspected SAH?

A

after 12 hours to prevent traumatic tap
only done in alert patient with no focal neurological deficit or papilloedema
after normal CT scan

11
Q

after SAH is confirmed, how can the cause be diagnosed?

A

cerebral angiography

- seldinger technique injects contrast via femoral artery then CT or MRI imaging (usually CT)

12
Q

possible complications of SAH?

A
death
re-bleeding (often kills patients in later weeks-months)
delayed ischaemic deficit
hydrocephalus
hyponatraemia
seizures
13
Q

how are aneurysms managed to prevent rebleeding?

A

endovascular techniques

surgical clipping

14
Q

atheroma and aneurysm?

A

aneurysms often occur secondary to atheroma in vessels e.g from smoking

15
Q

what is DIND?

A

delayed ischaemic neurological deficit
tendency for patients to develop cerebral ischaemia 3-12 days after SAH
irritation after bleeding and blood breakdown products floating around brain causes vessels to spasm/occlude
causes altered conscious level or focal deficit

16
Q

how is DIND managed?

A

nimodipine (CCB)

high fluid intake (IV drip, triple H therapy)

17
Q

how does DIND appear on CT?

A

black area around where SAH occurred represents dead brain tissue from ischaemia

18
Q

how does hydrocephalus present?

A

increasing headache over a week or so or altered conscious level if bad
often transient
present in most SAH cases but not always needed to treat

19
Q

how is hydrocephalus managed?

A

CSF drainage (lumbar puncture, shunt, external ventricular drain)

20
Q

2 main reasons for hyponatraemia?

A

SIAHD
cerebral salt wasting (abnormal secretion of hormone causing sodium excretion)
both occur as a result of SAH

21
Q

how is hyponatraemia 2ndary to SAH managed?

A

do not fluid restrict (usually would but not if 2ndary to SAH as it would cause vasospasm)
supplement sodium intake
fludrocortisone

22
Q

how does SAH affect seizure risk?

A

increased risk

give anticonvulsant prophylaxis if seizures do occur

23
Q

what usually causes intracerebral haemorrhage?

A

most secondary to hypertension

2nd most common = aneurysm or AVM

24
Q

how does hypertension cause ICH?

A

charcot bouchard microaneurysms arise on small perforating arteries
basal ganglia haematoma

25
Q

how does ICH present?

A

headache
focal neurological deficit
decreased conscious level

26
Q

how is ICH investigated?

A

CT scan - urgent if decreased conscious level

angiography of suspicion of underlying vascular anomaly

27
Q

how is ICH managed?

A

surgical evacuation of haematoma +/- treat underlying abnormality (AVM etc)
non-surgical management

28
Q

describe the prognosis in ICH?

A

good if small superficial clot and good neurological status

poor if large basal ganglia or thalamic clot with major focal deficit or deep coma

29
Q

where is intraventricular blood most likely to be seen on CT?

A

occipital horns of ventricles (at the bottom due to gravity)

30
Q

what causes intraventricular haemorrhage?

A

rupture of subarachnoid or intracerebral bleed into a ventricle

31
Q

what is an AVM?

A

arterio-venous shunt
usually intraparenchymal (within brain tissue)
usually congenital

32
Q

what can an AVM cause?

A

seizures
haemorrhage (intracerebral, subarachnoid, subdural)
headache
steal syndrome

33
Q

how is an AVM managed?

A
can be surgically excised
endovascular embolization
stereotactic radiotherapy
conservative
weigh risks against benefits