Intercranial Haemorrhage Flashcards Preview

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Flashcards in Intercranial Haemorrhage Deck (27):
1

What is usually the cause of a Subarachnoid haemorrhage?

Berry aneurysm (Circle of Wilis)

2

How does a Subarachnoid Haemorrhage present?

Sudden severe headache
Collapse
Vomiting
Neck pain
Photophobia

3

What are differentials for sudden onset headache?

Subarachnoid haemorrhage
Migraine
Benign coital cephalgia

4

What are signs of a Subarachnoid Haemorrhage?

Neck stiffness
Photophobia
Decreased conscious level
Focal neurology deficit (dysphasia, hemiparesis, 3rd nerve palsy
Retinal/Vitreous haemorrhage

5

When may a brain CT be negative?

>3 days post ictus

6

When is a lumbar puncture safe to perform?

In alert patient with no focal neurological deficit and no papiloedema after normal CT

7

Where is a cerebral angiography performed?

Via femoral artery using Seldinger technique

8

What may cause cerebral angigrophy to miss an aneurysm?

Vasospasm

9

What are possible complications of a Subarachnoid Haemorrhage?

Re-bleeding
Delayed ischaemic deficit
Hydrocephalus
Hyponatraemia
Seizures

10

When does delayed ischaemia occur?

Days 3-12

11

What are signs of delayed ischaemia?

Altered conscious level
Vasospasm

12

What are treatments for delayed ischaemia?

Nimodipine
High fluid intake (Triple H therapy)

13

What is hydrocephalus?

Increased intercranial CSF pressure

14

How dos hydrocephalus present?

Increasing headache
Altered conscious level
Often transient (not lasting)

15

What is the treatment for hydrocephalus?

CSF drainage
LP, EVD, shunt

16

What is a treatment fo hyponatraemia?

Fludrocortisone

17

What is an Intracerebral Haemorrhage?

Bleed into the brain parenchyma

18

What can cause an Intracerebral haemorrhage?

Hypertension
Aneurysm
Arteriovenous malformation

19

What are Charcot-Bouchard aneurysms?

Microaneurysms arising in small perforating arteries
A form of hypertensive Intracerebral haemorrhage
Basal Ganglia haematoma

20

How does an Intracerebral Haemorrhage present?

Headache
Focal neurological deficit
Decreased conscious level

21

How do you investigate an Intracerebral Haemorrhage?

CT scan if urgent decrease in conscious level
Angiography if suspicion of underlying vascular anomaly

22

How do you treat an Intracerebral Haemorrhage?

Surgical evacuation of haematoma +/- treatment of underlying abnormality

23

What is a good prognosis of an Intracerebral Haemorrhage?

If small superficial clot and good neurological status

24

What is a bad prognosis of an Intracerebral haemorrhage?

If large basal ganglia or thalamic clot with major focal deficit or deep coma

25

What is an Intraventricular Haemorrhage?

Occurs with rupture of subarachnoid or intracerebral bleed into a ventricle

26

What are treatments of Arteriovenous Malformations?

Surgery
Endovascular embolisation
Stereotactic radiotherapy
Conservative
Weigh risk vs benefit

27

Describe Arteriovanous malformations

Usually intraparenchymal
Possibly congenital
Seizures
Haemorrhages
Headache
Steal syndrome