Intracranial Bleeds

Question 1

What are some risk factors of an intracranial bleed? (8)

Answer 1

• Head injuries
• Hypertension
• Aneurysms
• Ischaemic strokes (progressing to bleeding)
• Brain tumours
• Thrombocytopenia (low platelets)
• Bleeding disorders (e.g., haemophilia)
• Anticoagulants (e.g., DOACs or warfarin)

Question 2

GCS score:
Patient localises to pain?

Answer 2

M5

Question 3

GCS score:
Patient has normal flexion away from pain?

Answer 3

M4

Question 4

GCS score:
Patient has a decorticate posture?

Answer 4

M3
Abnormal flexion to pain
Arms flexed hands at chin

Question 5

GCS score:
Patient abnormally extends?

Answer 5

M2
Extends with arms by side

Question 6

GCS score:
Patient speaking but confused?

Answer 6

V4

Question 7

GCS score:
Patient speaking but inappropriate words?

Answer 7

V3

Question 8

GCS score:
Patient making incomprehensible sounds?

Answer 8

V2

Question 9

GCS score:
Eyes respond to speech?

Answer 9

E3

Question 10

GCS score:
Eyes respond to pain?

Answer 10

E2

Question 11

What bloods should be done in intracranial bleeds?

Answer 11

• Bloods should include a full blood count (for platelets) and a coagulation screen.

Question 12

What are some surgical options for extradural and subdural Haematomas? (2)

Answer 12

○ Craniotomy (open surgery by removing a section of the skull)
○ Burr holes (small holes drilled in the skull to drain the blood)

Question 13

Where do extradural haemorrhages occur?

Answer 13

• Occurs between the skull and dura mater

Question 14

What artery is ruptured in extradural haemorrhage?

Answer 14

Middle meningeal artery

Question 15

What is an extradural haemorrhage often associated with?

Answer 15

Fracture of the temporal bine

Question 16

What shape is an extradural haemorrhage?

Answer 16

Biconvex

Question 17

What is the typical patient with an extradural haemorrhage?

Answer 17

• Young patient with a traumatic head injury and an ongoing headache.

Question 18

What is the typical presentation of an extradural haemorrhage?

Answer 18

• Period of improved neurological symptoms and consciousness, followed by a rapid decline over hours as the haematoma gets large enough to compress the intracranial contents.

Question 19

Where does a subdural haemorrhage occur?

Answer 19

• Occurs between the dura mater and arachnoid mater

Question 20

What shape is a subdural haemorrhage?

Answer 20

Crescent shape

Question 21

What is the typical patient with a subdural haemorrhage?

Answer 21

• Elderly and alcoholic patients, who have more atrophy in their brains, making the vessels more prone to rupture.

Question 22

Where does a subarachnoid haemorrhage occur?

Answer 22

• Involves bleeding in the subarachnoid space, where the cerebrospinal fluid is located, between the pia mater and the arachnoid membrane.

Question 23

What is usually the cause of a subarachnoid haemorrhage?

Answer 23

Ruptured cerebral aneurysm

Question 24

What is the presentation of a subarachnoid haemorrhage?

Answer 24

• Sudden-onset occipital headache during strenuous activity, such as heavy lifting or sex.
• The sudden and severe onset leads to the “thunderclap headache” description.

Question 25

When should LP be done after a subarachnoid haemorrhage?

Answer 25

> 12hours of onste

Question 26

What is seen on an LP in a subarachnoid haemorrhage?

Answer 26

Xanthochromia
Yellowing of CSF from bilirubin

Question 27

What is the typical presentation of an intracerebral haemorrhage?

Answer 27

• It presents similarly to an ischaemic stroke with sudden-onset focal neurological symptoms, such as limb or facial weakness, dysphasia or vision loss.

Question 28

Where does an intracerebral haemorrhage occur?

Answer 28

• Intracerebral haemorrhage involves bleeding in the brain tissue.