Intracranial Bleeds Flashcards
(24 cards)
What are the 4 types of ICH?
Extra dural haemorrhage
Sub dural haemorrhage
Intracerebral haemorrhage
Sub arachnoid haemorrhage
What are risk factors for ICH?
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)
What is the presentation?
SUDDEN ONSET HEADACHE is key
Also:
Seizures
Vomiting
Reduced consciousness
Focal neurological symptoms
Where does an extra dural occur?
Between skull and dura mater
What is an extra dural caused by?
Rupture in the middle meninges artery in temporoparietal region
Associated with a fracture of the temporal bone
What shape is an extra dural?
Bi-convex shape
Lemon
Limited by the cranial sutures
What is the typical history of an extradural?
Young patients
Traumatic head injury
Ongoing headache
Period of improved neurological symptoms and consciousness, followed by a rapid decline over hours as the haematoma becomes larger and compress intracranial contents
What is the typical history of an extradural?
Between dura and arachnoid mater
What causes sub dural?
Rupture of the bridging veins in outermost meningeal layer
What shape is subdural?
Crescent shape
Not limited by cranial sutures
Who do subdural occur in?
Elderly and alcoholic patients
They have atrophy in their brain, making vessels prone to rupture
What is an intracerebral haemorrhage?
Bleeding into the brain tissue
How does a intracerebral present?
Similar to an ischaemic stroke with sudden onset focal neurological symptoms, such as limb or facial weakness, dysphasia or vision loss
How can intracerebral occur?
Spontaneously
Or secondary to an ischaemic stroke, tumours or aneurysm rupture
Where in the brain tissue can they occur?
Anywhere in the brain tissue:
Lobar intracerebral haemorrhage
Deep intracerebral haemorrhage
Intraventricular haemorrhage
Basal ganglia haemorrhage
Cerebellar haemorrhage
Where does a subarachnoid haemorrhage occur?
Bleeding in the subarachnoid space, where the CSF is
What is a subarachnoid a result of?
Ruptured cerebral aneurysm
What is the history of a subarachnoid?
Sudden onset occipital headache during strenuous activity
“Thunderclap headache”
What is the immediate management?
Head CT
What bloods should be done?
FBC (platelets)
Coagulation screen
What will initial management be?
Admission to a specialist stroke centre
Discuss with a specialist neurosurgical centre to consider surgical treatment
Consider intubation, ventilation and intensive care if they have reduced consciousness
Correct any clotting abnormality (e.g., platelet transfusions or vitamin K for warfarin)
Correct severe hypertension but avoid hypotension
How can smaller bleeds be managed?
Possibly more conservatively
With close monitoring and repeat imaging
What are surgical management for extradural or subdural haematoma?
Craniotomy
Burr holes
