Spontaneous Intercranial Haemorrhage Flashcards Preview

Neurology > Spontaneous Intercranial Haemorrhage > Flashcards

Flashcards in Spontaneous Intercranial Haemorrhage Deck (36):
1

what are the types of spontaneous intracranial haemorrhage

subarachonid
intracerebral
intraventricular

2

what usually causes a spontaneous subarachnoid haemorrhage (SAH)

berry aneurysm rupture

sometimes AVM/ no underlying cause

3

what is the mortality like in spontaneous SAH

46% at 30 days
fatal if diagnosis missed

4

where do berry aneurysm arise from

junction of circle of willis

5

what is the presentation of a spontaneous SAH

sudden onset severe headache (like being hit by bat) (will persist due to chemical meningitis caused by blood)
collapse
vomiting
neck pain
photophobia
may have decreased consciouness

6

what are the differentials a sudden onset headache

SAH
migraine
benign coital cephalgia (severe sudden onset HA after exertion)

7

what are signs in a spontaneous SAH

neck stiffness
photophobia
-/+ decreased conscious level
+/- focal neurolofical deficit (dysphasia, hemiparesis, III nerve palsy)- depends which part of brain gets ischaemic/ damaged by blood
on fundoscopy- retinal or vitreous haemorrhage

8

what diagnostic test for SAH

CT
may be negative if >3 days post
negative in 15% of patients who have bled

9

what colour is CSF on CT

black- low density

10

what colour is blood on CT

high density- bright as lots of ions

11

when can you so a LP in suspected SAH

if CT is negative
when no focal neuro deficit and no papilloedema

12

what will CSF look like in an LP of SAH

bloodstained or xanthochromic (yellow staining due to breakdown of blood products)

differentiate from a traumatic tap

13

what is the gold standard for a SAH

cerebral angiography

14

what are the complications of SAH

re bleeding - often fatal
delayed ischaemic deficit
hydrocephalus
hyponatraemia
seizures

15

how do you prevent re bleeding in a spontaneous SAH

endovascular techniques to exclude aneurysm from circulation (e.g. platinum coil)
surgical clipping

16

how do atheromas cause aneurysm

inflammatory damage from the atheroma, damage vessels

17

what are the features of a delayed ischaemia in SAH

happens 3-12 days after bleed
-altered conscious level of focal deficit

caused by the inflammatory response to the blood irritates the vessels and causes them to go into vasospasm

18

what treatment for a delayed ischaemia in an SAH

nimodipine- calcium channel blocker
triple H fluid therapy- achieve hypervolaemia, hypertension, hemodilution

19

what is the treatment for hydrocephalus in SAH

CSF drainage- LP, EVD, shunt

20

what can cause hyponatraemia in SAH

SIADH
cerebral salt wasting (abnormal secretion of hormones that cause salt excretion)

21

what is the treatment for hyponatraemia in SAH

often transient
DO NOT fluid restrict as will cause vasospasm in SAH
supplement sodium intake
fludrocortisone- encourages sodium retention

22

what does SAH do to seizure threshold

decreases it
can give anticonvulsant prophylaxis- controversial

23

what is the general treatment for a spontaneous SAH

CT +/- LP
bedrest
analgesia
anti emetic
IV fluids
refer to neurosurgeons

24

what is the outcome for a spontaneous SAH usually

poor
high mortality
those that do 'well' 66% don't return to previous occupation

25

what usually causes an spontaneous intracerebral haemorrhage

50% hypertension
30% aneurysm/ AVM

bleeding diatheses, tumours, drugs (warfarin, heparin)

26

what is an intracerebral haemorrhage (ICH)

bleeding into the brain parenchyma

27

what causes a hypertensive ICH

microaneurysms arising on small perforating arteries
creates a basal ganglia haematoma

28

what is the presentation of a spontaneous ICH

headache that is not as sudden onset of severe as SAH
focal neurological deficit
decreased conscious level in big bleeds (reduced cerebral perfusion)

29

what investigations into ICH

CT - urgent if decreased conscious level
angiography if suspicious of underlying vascular anomaly (dont need to do in classical hypertensive basal ganglia bleed)

30

what is the treatment for a spontaneous ICH

surgical evacuation of heamatoma +/- treatment of underlying abnormality (esp if decreased conscious level)

non surgical management (if normal conscious level)

31

what is the prognosis for spontaneous ICH

good- if small superficial clot and good neurological status

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

32

what causes an spontaneous intraventricular haemorrhage

rupture of a subarachnoid or intracerebral bleed into a ventricle
(any combo of SAH, ICH and intraventrciular haemorrhage can occur)

33

what are AVMs in the brain like

arterio venous shunts
usually intraparenchymal
congenital

34

what are the complications of a brain AVM

seizures
haemorrhage- ICH, SAH, subdural
headache
steal syndrome s

35

what surrounds an AVM

draining veins

36

what is the treatment for AVMs

surgery - excision
endovasular embolisation
stereotactic radiotherapy (gamma rays slowly shrink it)
conservative

weight risks and benefits