3: Intracranial haemorrhage Flashcards Preview

Neurology Week 5 2018/19 > 3: Intracranial haemorrhage > Flashcards

Flashcards in 3: Intracranial haemorrhage Deck (56)
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1

Intracranial haemorrhage can be spontaneous or brought on by a ___ ___.

head injury

2

What underlying pathology is usually responsible for subarachnoid haemorrhage?

Berry aneurysm

3

What is a congenital problem which can cause subarachnoid haemorrhage?

AVM

4

The subarachnoid space is found between the ___ and the ___.

arachnoid, pia

5

Which type of haemorrhage is relatively common and may be related to a Berry aneurysm?

Subarachnoid haemorrhage

6

Which circulation does a Berry aneurysm affect?

Circle of Willis

7

Where in the Circle of Willis do Berry aneurysms tend to form?

Bifurcations

branch points between one artery and the next

8

What is the presentation of a subarachnoid haemorrhage?

Headache - sudden & severe; "worst headache of my life"; persistent

Syncope

Vomiting - almost always

Neck pain - irritation of meninges in spinal cord subarachnoid space

Photophobia - ""

9

Subarachnoid haemorrhage and meningitis have similar presentations.

How do you tell the difference?

Subarachnoid haemorrhage presents with sudden onset headache

Meningitis headache has a gradual onset

10

Why do headaches seen in subarachnoid haemorrhage have a sudden onset?

Aneurysm collapses and SYSTOLIC BP transferred into parenchyma (i.e it occurs very quickly)

11

What type of meningitis is caused by subarachnoid haemorrhage?

Chemical meningitis - due to the blood

12

Which type of headache may mimic that of a subarachnoid haemorrhage?

How would you tell the difference?

Migraine

Aura

13

What is benign coital cephalgia?

Sudden onset headache during / after sex

14

What are the clinical signs of subarachnoid haemorrhage?

Neck stiffness

Photophobia

Reduced conscious level

Focal neurological deficit e.g CN palsy

15

Which cranial nerve palsy is associated with brain aneurysms?

Which artery is implicated?

CN III palsy "down and out"

Posterior communicating artery

16

What is the first-line investigation for patients with subarachnoid haemorrhages?

CT brain

17

Is a CT brain 100% specific for subarachnoid haemorrhage?

No

18

What colour is fresh blood on a CT scan?

White

19

What colour is CSF on a CT scan?

Black

20

Where will blood be seen on a CT brain of someone with a subarachnoid haemorrhage?

Fissures, cisterns

i.e not in the ventricles

21

CT brain is the first-line investigation for subarachnoid haemorrhage, but it may be negative.

What is the gold standard investigation?

What is seen in subarachnoid haemorrhage?

Lumbar puncture

Bloody / "xanthochromic" CSF

22

What is xanthochromia in terms of a CSF sample?

Yellow-ish staining of CSF - blood breakdown products; indicative of subarachnoid haemorrhage

23

How do you tell the difference between bloodstained CSF (in subarachnoid haemorrhage) and a traumatic tap?

Take three samples

if amount of blood decreases with each tap, it's traumatic

24

Which imaging can be used to visualise blood vessels in cerebrovascular disease?

CT / MRI angiography

25

How long does bleeding actually last for in a subarachnoid haemorrhage?

< 1 second

because of compression, vasospasm etc. closing the bleed

26

Aneurysms which have burst are at major risk of ____ in the next two weeks.

rebleeding

fatal complication of subarachnoid haemorrhage

27

How is rebleeding prevented in patients with ruptured cerebral aneurysms?

Endovascular techniques

feeding through a catheter and planting metal coils

28

Metal coils are implanted using a catheter to prevent ___ of ruptured aneurysms.

rebleeding

29

Apart from endovascular techniques, what else can be used to stop aneurysms from rebleeding?

Surgical clips

30

What is a complication of subarachnoid haemorrhage which can occur 3 - 12 days following a bleed?

Delayed ischaemia