subarachnoid and subdural haemorrhage

Question 1

causes of subarachnoid haemorrhage

Answer 1

Aneurysm rupture
Traumatic
Arteriovenous malformations (unusual link between artery and vein)
Ctyptogenic

Question 2

Presentation of. SAH

Answer 2

A severe global headache that reaches maximum intensity with seconds

May lose consciousness or vomit at onset

Over time photophobia and neck stiffness

Question 3

What are the signs of SAH

What happens if a posterior communicating artery aneurysm

Answer 3

May have a low GCS score (low consciousness)
-Third nerve palsy with dilated pupil if posterior communicating artery aneurysm. (this means they have a completely closed eyelid and eye looks down and outwards. Pupil is also fixly dilated and doesn’t react to light)

Neck stiffness

Sub hyaloid haemorrhage seen in pupil

Question 4

how to diagnose a SAH

-What if first investigation fails

Answer 4

Very urgent CT

-If CT scan normal, do lumbar puncture after 12 hours to look for xanthochromia

Question 5

how to manage SAH

Answer 5

Urgent neurosurgical referral for definitive treatment

• OFten interventional near-radiology
• IV nimodipine to stop spasms of artery

Question 6

Complications of SAH

Answer 6

Rebleed 
Seizures 
Vasospasm 
Hydrocephalus 
Electrolyte abnormalities
ECG abnormalities (ST depression, T wave inversion)
Pulmonary oedema

Question 7

Symptoms of meningism

Answer 7

headache
Photophobia
Nausea

Question 8

Signs of meningism

Answer 8

Nuchal rigidity: neck resists passive flexion
Kernig’s sign-passive knee extension in supine patient elicits neck and hamstring pain and further resistance to further extension
Brudzinski sign-passive flexion of the neck while the patient is in a supine position results in flexion of the hips and knees

Question 9

Causes of meningism

Answer 9

Meningitis

SAH

Question 10

cause of subdural haemorrhage

-What risk factors

Answer 10

rupture of bridging cortical veins

• More likely to tear in older patients with fragile veins and more space between brain and dura
• Anticoagulants increase risk

Question 11

Features of a subdural haemorrhage

Answer 11

Slower rate of bleeding

Question 12

Cause of of hemiparesis (weakness in one side of body) with third nerve palsy and drowsiness
-Why

Answer 12

Haematoma

Haematoma compresses hemisphere (hemiparesis cause) then that compresses posterior communicating artery (third nerve palsy) and the drowsiness is because of problems with both hemispheres or the brainstem

Question 13

What are the causes of a third nerve palsy with a fixed dilated pupil

Answer 13

Haematoma

POsterior communicating artery aneurysm

Question 14

features of acute SDH

Answer 14

Loss of consciousness, low gCS, anisocoria (difference in pupil size), motor deficit

Lucid interval–> after the injury where the patient appears relatively well and normal but subsequently deteriorates and loses consciousness as the haematoma forms

hyper dense on CT

Requires surgical evacuation

Question 15

features of a chronic SDH

Answer 15

> 2 weeks
Subtle signs, weakness, hemiparesis
Isodense or hypodese to parenchyma
Management can be surgical vs conservative

Question 16

SDH rik factors

Answer 16

Elderly: Cerebral atrophy and increased venous fragility
Seizures 
Alcohol
Anticoagulants
Bleeding disorders
head trauma 
Intervranial surgery

Question 17

Complications of SDH

Answer 17

Death due to cerebellar herniation 
Raised ICP 
Cerebral oedema 
Recurrent haematoma 
Seizures 
Infection, empyemas meningitis 
Permanent neurological or cognitive defict
COma/ persistent vegetative state