intracranial bleeds

Question 1

first line investigaiton of subarachnoid

Answer 1

non-contrast CT

blood = hyperdense/bright on CT

Question 2

SAH - CT done within 6hrs of sx onset but normal, next step?

Answer 2

consider alternative diagnosis
- do NOT do a lumbar puncture

if within 6hrs of sx onset

Question 3

SAH - if CT head done after 6hrs of sx onset + normal, next step?

Answer 3

do an lumbar puncture

• should be done at least 12hrs following sx onset to allow development of xanthochromica (result of RBC breakdown)

Question 4

evidence of SAH on CT head - next step?

Answer 4

refer to neurosurgery

• CT intracranial angiogram (to intentify aneurysm/AVM)
  +/- digital subtraction angiogram

Question 5

how are intracranial aneurysms treated

Answer 5

coil by interventional neuroradiologists, soe require craniotomy + clipping by neurosurgeon

(risk of rebleeding, require prompt intervention - within 24hrs)

Question 6

complications of aneurysmal SAH

Answer 6

rebleeding - in 1st 12hrs
hydrocephalus

vasospasm -> typically 7-14days after onset

hypOnatraemia –> due to SIADH
seizures