Intra cranial haemorrhage Flashcards Preview

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Flashcards in Intra cranial haemorrhage Deck (19)
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1

3 Classifictions of spontaneuous intracranial hameorrhage

Sub Arachnoid

Intracerebral

Intraventricular

2

What are the underlying cause of subarachnoid haemorrhage

USUALLY berry aneurysm

Can be AVM or no underlying cause

3

SAH presentation

Sudden onset severe headache

Collapse

Vomiting

Neck pain

Photophobia

4

Signs in SAH

Neck stiffness
Photophobia
Decreased concious level
Focal neuro deficit
Retinal or vitreous haemorrhage

5

When is lumbar puncture indicated?

In alert patient with no focal neuro deficit or papilloedema
or
after normal CT

6

What is xanthochromia?

The yellow appearance of CSF on LP caused by bilirubin in the CSF, which can point towards a SAH.

7

What is the gold standard investigation of SAH?

Cerebral angiography +/- CT or MRI

Note may occasionally miss aneurysm due to vasospasm

8

Complications of SAH

Re bleeding (-->death)
Delayed ischaemic deficit
Hydrocephalus
Hyponatraemia
Seizures

9

Treatment of rebleeding

Endovascular techniques (GOLD STANDARD)

Surgical clipping for difficult cases

10

Which drug should be used to prevent the effects of delayed ischaemia following SAH

Nimodipine

11

Treatment of Hydrocephalus

CSF drainage in the form of LP, External ventricular drainage or shunt

12

Management of hyponatraemia

Do not fluid restrict

Supplement sodium intake

Fludrocortisone

13

Causes of intracerebral haemorrhage

50 % Hypertension

30% due to aneurysm or AVM

14

Presentation of ICH

Headache

Focal neuro deficit

Decreased conscious level

15

Pathophysiology of Hypertensice ICH

Charcot bouchard microaneurysms arising on small perforating arteries

16

Investigation of ICH

CT- urgent if decreased concious

Angiography is suspicion of vascular anomaly

17

Treatment of ICH

Surgical evacuation of haematoma +/- treat underlying abnormality

18

What is an intraventricular haemorrhage

Occurs with rupture of a SAH or ICH into a ventricle

19

Treatment of AVM

Surgery

Endovascular embolisation

Sterotactic radiotherapy

Conservative

Weigh risks against benefit