5.3 Intracranial haemorrhage Flashcards
(17 cards)
SO severe headache collapse vomiting neck pain photophobia
Subarachnoid haemorrhage
ddx sudden onset headache
SAH
migraine
benign coital cephalgia
when can CT brain be negative post -SAH?
if >3 days post-ictus
negative in 15% of pts who have bled anyways
when is LP safe?
- alert pain + no focal neuro deficit + no papilloedema
OR - after normal CT scan
When can you find xanthochromic CSF?
6-48 hours post-ictus
differentiate it from a traumatic tap
complications of SAH
re-bleed delayed ischaemic deficit (stroke!) hydrocephalus hyponatraemia seizures
when is re-bleed risk higher?
- first 14 days or
- first 6 months?
trick question
-20% risk of re-bleed is in first 14 days
then it accumulates to
-50% risk of bleed in first 6 months
high risk period for delayed ischaemia
days 3-12
management of delayed ischaemia
nimodipine
high fluid intake
triple H therapy - hypertension, hypervolaemia, haemodilution
how do you manage hyponatraemia/SIADH in intracranial haemorrhage?
do not fluid restrict
supplement Na+ intake
fludrocortisone
major causes of intracerebral haemorrhage
50% due to HTN
30% due to aneurysm or AVM
what is charcot-bouchard?
microaneurysms arising on small perforating arteries
presentation of ICH?
headache
focal neuro deficit
decreased LOC
tx of ICH
surgical evauation of haematoma
treat underlying abnormality
or - non-surgical mx
poor px indicators of ICH
large basal ganglia or thalamic clot
major focal deficit or deep coma
2 sources of intraventricular haemorrhage
rupture of subarachnoid or intracerebral bleed
what kinds of haemorrhage can AVMs cause?
intracerebral
subarachnoid
subdural
