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ESA 5 - Nervous System > Acute Intracranial Events > Flashcards

Acute Intracranial Events Flashcards

(56 cards)

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1
Q

What is an extradural haemorrhage?

A

Collection of blood between inner surface of skull, and periosteal dura mater

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2
Q

What causes extradural haemorrhagers?

A

Nearly always secondary to trauma and/or skull fracture

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3
Q

Who do extradural haemorrhages typically occur in?

A

Younger patients

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4
Q

What % of extradural haemorrhage cases involve a severed artery?

A

90%

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5
Q

What artery is most commonly severed in extradural haemorrhages?

A

Middle meningeal artery

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6
Q

How common is venous involvement in extradural haemorrhages?

A

Rare

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7
Q

What is venous involvement in extradural haemorrhages usually the rest of?

A

Torn venous sinus

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8
Q

What % of extradural haemorrhages are supratentorial?

A

95%

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9
Q

How do patients with extradural haemorrhages present?

A

Loss of consciousness, due to impact of injury

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10
Q

What happens after the initial loss of consciousness in a patient with an extradural haemorrhage?

A
  • There is a transient recovery with ongoing haemorrhage, known as the lucid interval in 40% of patients
  • As haemotoma enlarges, ICP will increase, causing compression of the brain and rapidly deterorating level of consciousness
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11
Q

What might be found on examination in a patient with a progressing extradural haemorrhage?

A

Cranial nerve palsies

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12
Q

Why might cranial nerve palsies present in patients with extradural haemorrhages?

A

Due to herniation of brain structures

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13
Q

What is the prognosis of an extradural haemorrhage?

A

Generally good with early intervention

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14
Q

How is a small extradural haemorrhage managed?

A

Observed and managed conservatively, with neurological follow up

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15
Q

How is a large extradural haemorrhage managed?

A

Referral to neurosurgery for craniotomy and clot evacuation

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16
Q

What are the potenital complications of extradural haemorrhages?

A
  • Pernament brain damage
  • Coma
  • Seizures
  • Weakness
  • Pseudoaneurysm
  • Arteriovenous fistula
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17
Q

What is a subdural haemorrhage?

A

Collection of blood between meningeal dura mater and arachnoid mater

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18
Q

What age groups can subdural haemorrhages occur in?

A

All

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19
Q

What are the categories of subdural haemorrhages?

A
  • Acute (<3 days)
  • Subacute (3-21 days)
  • Chronic (>3 weeks)
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20
Q

Why does bleeding occur in a subdural haemorrhage?

A

Due to shearing forces on cortical bridging veins

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21
Q

What causes subdural haemorrhages?

A

Most often associated with trauma, but can be spontaneous

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22
Q

What increases the risk of rupture of subdural haemorrhages?

A

Cerebral atrophy

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23
Q

What setting do acute subdural haemorrhages usually present?

24
Q

What % of acute subdural haemorrhage patients present with neurological abnormalities?

25
Who is subacute/chronic subdural haemorrhages more common in?
The elderly, with vague or absent history of head trauma
26
How might subacute/chronic subdural haemorrhages present?
With insidious onset of confusion and general cognitive decline similar to dementia
27
How do acute subdural haemorrhages appear on CT?
Generally, hyperdense *i.e. brighter than brain tissue*
28
What happens to the CT appearance of haemotoma caused by a subdural haemorrhage over time?
It will progressively become hypodense, *i.e. darker than brain tissue*
29
How can small chronic haematomas caused by subdural haemorrhages be evaluated?
Serial imaging
30
What do collect subdural haemorrhages require?
Immediate neurosurgical intervention
31
How are symptomatic subacute/chronic subdural haemorrhages treated?
Via one or more burr holes
32
What is the prognosis of subdural haemorrhages?
Relatively poor compared to extradural haemorrhages
33
What is the mortality in acute subdural haemtomas requiring surgery?
May exceed 50%
34
What patients have worse outcomes of subdural haemotomas?
Those who are anticoagulated
35
What % of patients recover fully from subdural haemorrhages?
20%
36
Describe the shape of an extradural haemorrhage
Lentiform / biconvex, *e.g. like a lemon*
37
Describe the shape of a subdural haemorrhage?
Crescent / sickle, *e.g. like a banana*
38
What is a subarachnoid haemorrhage?
Collection of blood between the arachnoid mater and the pia mater
39
In whom do subarachnoid haemorrhages usually occur?
Middle aged patients, \<60
40
What causes subarachnoid haemorrhages?
* Vast majority occur spontaneously, secondary to ruptured berry aneurysms * May be traumatic
41
How do patients with a subarachnoid haemorrhages present?
* Sudden onset 'thunderclap' headache * Meningism * Nausea and vomiting * Fever * Focal neurological deficits * LOC
42
What are the symptoms of berry aneurysms?
Largely asymptomatic, but symptoms may arise if compressing nearby structures, or during early stages of rupture
43
What % of the population have one or more berry aneurysm?
Around 3%
44
What can be done to berry aneurysms with a high risk of rupture?
Surgical clipping and endovascular coiling
45
What are the risk factors for berry aneurysms?
* Family history * Hypertension * Heavy alcohol consumption * Abnormal connective tissue
46
Give 4 examples of abnormal connective tissue diseases
* Autosomal dominant polycystic kidney disease * Erlers-Danlos * Neurofibromatosis * Marfan's disease
47
What % of berry aneurysms form in the anterior cerebral artery?
40%
48
What % of berry aneurysms form at the junction of the internal carotid artery with the posterior communicating artery
20%
49
What % of berry aneurysms form in the middle cerebral artery?
34%
50
What % of berry aneurysms occur at the bifurcation of the basilar artery?
4%
51
What is performed to aid diagnosis of a subarachnoid haemorrhage?
Lumbar puncture
52
What is looked for in the lumbar puncture that might suggest a diagnosis of subarachnoid haemorrhage?
* Presence of RBCs * Xanthochromia
53
How are subarachnoid haemorrhages managed?
* Stabilise the patient * Prevent rebleeding * Treat cerebral vasospasm * Correct hyponatraemia * Neurosurgical intervention *if large bleed*
54
What does the prognosis of subarachnoid haemorrhages depend on?
* GCS * Degree of neurological deficit at the time of presentation * Co-morbidities
55
What is the mortality of subarachnoid haemorrhages?
Between 30 and 90%
56
What are the complications of subarachnoid haemorrhages?
* Hydrocephalus * Focal neurological deficits * Coma * Seizures * Cognitive decline * Frequent headaches * Hypopituitarism

ESA 5 - Nervous System (18 decks)

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