Intracranial Haemorrhage Flashcards
Causes of intracranial haemorrhage
Trauma Hypertension Vascular malforamtions Infection Intracranial tumours Bleeding disorders Drugs Iatrogenic
Clinical features of raised ICP
Headache
Nausea and vomiting
Blurred vision
Decreased level of consciousness
Clinical features of focal neurological deficit
Motor hemiparesis/hemiplegia Sensory deficit Cranial nerve deficit Balance and co-ordination problems Speech and language problems
Investigations for intracranial haemorrhage
FBC and platelets Prothrombin time Serum chemistries Toxicology screen Serum alcohol level Screening for haematological, vascular and infectious aetiology CT MRI Angiography ECG Lumbar puncture
Clinical features of aneurysmal subarachnoid haemorrhage
Sudden severe thunderclap headache Nausea and vomiting Photophobia Meningism – neck pain Decreased level of consciousness Focal neurological deficit Seizures
Investigations into aneurysmal subarachnoid haemorrhage
CT LP if CT negative Cerebral angiogram Biochemistry Haematology
Medical management of aneurysmal subarachnoid haemorrhage
Analagesics Antiemetics Nimodipine Stool softeners TED stockings Fluid administration for hypertension, hypervolaemia, hyperdilution
Surgical management of aneurysmal subarachnoid haemorrhage
Endovascular embolisation
Surgical clipping
Complications of aneurysmal subarachnoid haemorrhage
Re-bleeding Cerebral vasospasm Hydrocephalus Seizures Complications associated with immobility Hyponatraemia
Anatomical locations of aneurysms
Extradural – between bone and dura
Subdural – between dura and arachnoid mater
Subarachnoid – below the arachnoid mater
Intracerebral – inside the brain tissue
Intraventricular – inside the ventricles
What anatomical locations of haemorrhages are a result of trauma?
Extradural
Subdural
Subarachnoid
What anatomical locations of haemorrhages occur spontaneously?
Intracerebral
Intraventricular
Medical treatment of aneurysmal intracranial haemorrhage
Intubation if decreased level of consciousness and poor airway protection
Lower BP to MAP < 130mmHg (avoid excessive hypotension)
Stabilise vital signs
Intubate and hyperventilate if ICP is increased
Correct any coagulopathies with plasma, vitamin K etc.
Anticonvulsant for seizure activity
Surgical treatment of aneurysmal intracranial haemorrhage
Craniotomy and clot evacuation
Stereotactic aspiration with thrombolytic agents
Endoscopic evaluation
Clipping/coiling of aneurysm
Causes/risk factors for haemorrhagic infarction
Atherosclerosis Small vessel disease Cardioembolism Vasculitis Arterial dissection Polycythaemia/thrombocythaemia Meningitis Hypercoagulability Anticoagulation therapy
