Intracranial Bleeds

Question 1

What are the risk factors of an intracranial bleed?

Answer 1

head injuries
hypertension
aneurysms
ischaemic strokes
brain tumours
thrombocytopenia (low platelets)
bleeding disorders (haemophilia)
anticoagulants (DOACs and warfarin)

Question 2

How do intracranial bleeds present?

Answer 2

sudden onset headache
seizures
vomiting
reduced consciousness
focal neurological symptoms (e.g., weakness)

Question 3

Describe the Glasgow coma scale.

Answer 3

max of 15, min of 3, 8 or less = airways support required
eyes - scored from 1-4
4. opened spontaneously
3. opened in response to speech
2. opened in response to pain
1. none
verbal
5. orientated
4. confused
3. inappropriate words
2. incomprehensible sounds
1. none
motor
6 obeys commands
5. localises pain
4. normal flexion
3. abnormal flexion
2. extends
1. none

Question 4

How do you manage an intracranial bleed?

Answer 4

immediate CT
bloods - FBC (platelets) and coagulation screen
correct clotting abnormality and severe hypertension

Question 5

What is found in the subarachnoid space?

Answer 5

CSF

Question 6

What are the risk factors of subarachnoid haemorrhages?

Answer 6

45-70
women
black ethnic origin
hypertension
smoking
excessive alcohol intake
FHx
cocacine use
sickle cell anaemia
connective tissue disorders
neurofibromatosis
autosomal dominant polycystic kidney disease

Question 7

How does a subarachnoid haemorrhage present?

Answer 7

sudden onset occipital headache
neck stiffness
photophobia
vomiting
neurological symptoms

Question 8

What investigations should be carried out in a suspected subarachnoid haemorrhage?

Answer 8

CT head = first line (less reliable >6hrs later, normal CT head does not exclude)
if normal CT - lumbar puncture -> raised red cell count + xanthochromia (yellow colour to CSF caused by bilirubin)
CT angiography used once confirmed diagnosis to locate bleeding source

Question 9

How can subarachnoid haemorrhages be treated?

Answer 9

• surgical intervention can be used to treat aneurysms -> endovascular coiling (catheter in arterial system)
• nimodipie -> CCB used to prevent vasospasm which is a common complication that results in ischaemia