Brain Bleeds and Haemorrhages

Question 1

What does a subarachnoid haermorrhage involve

Answer 1

Bleeding into the subarachnoid space where the CSF is located (pia mater and archnoid mater)

Question 2

Usual cause of subarachnoid haemorrhage

Answer 2

Ruptured cerebral aneurysm

Question 3

History of subarachnoid haemorrhage

Answer 3

Sudden onset occipital headache that occurs during strenuous activity. ‘thunderclap headache’

Question 4

Features of subarachnoid haemorrhage

Answer 4

Neck stiffness, photophobia, vision changes, neurological symptoms such as speech change, weakness, seizures, loss of consciousness

Question 5

Risk factors for subarchnoid haemorrhage

Answer 5

HTN, smoking, excessive alcohol consumption, cocaine use, family history

Question 6

What population groups are subarachnoid haemorrhages more common in

Answer 6

Black patients, females and age 45-70

Question 7

What are subarachnoid haemorrhages particularly associated with

Answer 7

Cocaine use, sickle cell anaemia, connective tissue disorders, neurofibromatosis, autosomal dominant PCKD

Question 8

CT scan of subarachnoid haemorrhage

Answer 8

Hyperdense area in centre of brain expanding bilaterally.

Question 9

LP in subarachnoid haemorrhage

Answer 9

If CT is negative CSF can be tested for signs - RCC raised, xanthochromia

Question 10

What is done to locate the source of subarachnoid haemorrhage

Answer 10

CT or MRI angiography

Question 11

Management of subarachnoid haemorrhage

Answer 11

Surgical intervention, Nimodipine, LP and antiepileptic medications

Question 12

Surgicaal interventions used to treat subarachnoid haemorrhage

Answer 12

Coiling or clipping

Question 13

What does surgical coiling involve

Answer 13

Inserting a catheter into the arterial system, placing platinum coild into aneurysm and sealing it off from artery

Question 14

What does surgical clipping involve

Answer 14

Involves cranial surgery and putting clip on the aneurysm to seal it off

Question 15

What is the role of Nimodipine in subarachnoid haemorrhages

Answer 15

Calcium channel blocker which is used to prevent vasospasm - a common complication that can result

Question 16

Why is an LP used in management of subarachnoid haemorrhage

Answer 16

To treat hydrocephalus

Question 17

Risk factors for intracranial bleeds

Answer 17

Head injury, HTN, aneurysms, ischaemic stroke can progress to haemorrhage, brain tumours, anticoagulants

Question 18

Types of intracranial bleeds

Answer 18

Subdural, extradural, intracerebral and subarchnoid

Question 19

Where is the bleed in subdural haemorrhage

Answer 19

Dura and arachnoid mater

Question 20

Causes of subdural haemorrhage

Answer 20

Rupture of bridging veins

Question 21

Presentation of subdural haemorrhage

Answer 21

Acute or chronic, tending to present gradually with increasing headache and confusion.

Question 22

Who are subdural haemorrhages more likely to occur in

Answer 22

Elderly patients and alcoholic due to atrophy in brain

Question 23

Causes of subdural haemorrhage

Answer 23

History of trauma, alcohlism and anticoagulation, accerlation-deceraltion injury

Question 24

What does subdural haemorrhage look like on CT

Answer 24

Crescent shape, following contours of skull as it is not limited by cranial sutures

Question 25

Difference between acute and chronic subdural haemorrhage on CT

Answer 25

Hyperdense is acute, and hypodense is chronic

Question 26

Where is the bleed in an extradural haemorrhage

Answer 26

Skull and dura mater

Question 27

Cause of extradural haemorrhage

Answer 27

Trauma to pterion, associated with fracture to temporal bone

Question 28

Which vessels bleeds in extra dural haemorrhage

Answer 28

Middle meningeal artery

Question 29

History of extradural haemorrhage

Answer 29

Young patient with traumatic head injury that has ongoing headache. Period of improved symptoms and consciousness followed by rapid decline as haematoma compresses intracranial contents

Question 30

Symptoms of extradural haemorrhage

Answer 30

Acute severe headache, loss of consciousness, lucid interval then rapid deterioration

Question 31

CT image of extradural haemorrhage

Answer 31

Hyperdense bioconvex shape limited by cranial sutures

Question 32

Where is an intracerebral haemorrhage

Answer 32

Bleeding into the brain tissue

Question 33

Presentation of intracerebral haemorrhage

Answer 33

Similar to ischaemic stroke

Question 34

Which areas of brain tissue can be affected

Answer 34

Lobar, deep intracerebral, intraventricular, basal ganglia and cerebellar

Question 35

Causes of intreacerebral haemorrhage

Answer 35

Spontaneously or as a result of bleeding into an ischaemic infarct or tumour or rupture of aneurysm