Intracranial Haemorrhage

Question 1

What are the 3 types of intracranial haemorrhage?

Answer 1

Subarachnoid Haemorrhage
Intracerebral Haemorrhage
Intraventricular Haemorrhage

Question 2

What is subarachnoid haemorrhage?

Answer 2

Bleeding into the subarachnoid space

Question 3

What is the usual cause of a subarachnoid haemorrhage?

Answer 3

berry aneurysm

Question 4

Symptoms of subarachnoid haemorrhage?

Answer 4

Sudden onset severe headache
Collapse
Vomiting
Neck pain
Photophobia

Question 5

Name the 3 main differentials of a sudden onset headache?

Answer 5

Subarachnoid Haemorrhage
Migraine
Benign coital cephalgia

Question 6

Sigsn of subarachnoid haemorrhage?

Answer 6

Decreased conscious level

Focal neurological deficit (dysphasia, hemiparesis, IIIrd n. palsy)

Question 7

SAH signs on fundoscopy?

Answer 7

retinal or vitreous haemorrhage

Question 8

In SAH, when may CT scan be negative?

Answer 8

May be negative if >3days post ictus

Negative in 15% of patients who have bled

Question 9

What will a lumbar puncture help differentiate SAH from?

Answer 9

from ‘traumatic tap’

Question 10

What will CSF be like in SAH?

Answer 10

bloodstained or xanthochromic CSF

Question 11

When may lumbar puncture not be safe?

Answer 11

focal symptoms

papilloedema

Question 12

What technique is used in Cerebral Angiography?

Answer 12

Seldinger technique

Question 13

Complications of SAH?

Answer 13

Re-bleeding
Delayed ischaemic deficit
Hydrocephalus
Hyponatraemia
Seizures

Question 14

What is hydrocephalus?

Answer 14

Increased intracranial CSF pressure, often asymptomatic

Question 15

What may symptoms of hydrocephalus be?

Answer 15

Increasing headache or altered conscious level

Question 16

Treatment of hydrocephalus?

Answer 16

CSF drainage - LP, EVD, Shunt

Question 17

Treatment of hyponatraemia/ SIADH?

Answer 17

Do not fluid restrict
supplement sodium intake
fludrocortisone

Question 18

What is Intracerebral Haemorrhage?

Answer 18

Bleeding into brain parenchyma

50% of time due to hypertension, may also be due to aneurysm or arteriovenous malformation

Question 19

In hypertensive ICH, what arises on small perforating arteries?

Answer 19

‘Charcot- Bouchard’ microaneurysms

Basal ganglia haematoma

Question 20

Presentation of ICH?

Answer 20

Headache
Focal neurological deficit
Decreased conscious level

Question 21

Investigations of ICH?

Answer 21

CT scan - urgent if decreased conscious level

Angiography if suspicion of underlying vascular anomaly

Question 22

Treatment of ICH?

Answer 22

Surgical evacuation of haematoma +/-treatment of underlying abnormality

Question 23

What is the name for rupture of a subarachnoid or intracerebral bleed into a ventricle?

Answer 23

intraventricular haemorrhage - any combination of subarachnoid, intracerebral and intraventricular haemorrhage can occur

Question 24

What drugs can cause spontaneous intracranial haemorrhage?

Answer 24

warfarin, heparin