INTRACRANIAL BLEEDS- extra/subdural haematoma + SAH Flashcards
(45 cards)
Risk factors- intracranial bleeds?
Risk factors
-Head injury
-Hypertension
-Aneurysms
-Ischaemic stroke can progress to haemorrhage
-Brain tumours
-Anticoagulants e.g. warfarin
Presentation- intracranial bleeds?
-Sudden onset headache
-Seizures, weakness, vomiting, reduced consciousness, other sudden onset neurological symptoms
what is used to assess the level of consciousness and what is it marked out of?
Glasgow coma scale
3-15
Eye opening response- out of 4
Verbal response- out of 5
Motor response- out of 6
15= best response
8 or less= comatose
3= totally unresponsive
Name the criteria for the eye opening response- GCC
4- spontaneously
3- to speech
2- to pain
1- unresponsive
Name the criteria for the verbal response- GCC
5- can orientate time, place + person
4- confused
3- inappropriate words
2- incoherent sounds
1- unresponsive
Name the criteria for the motor response- GCC
6- can follow commands
5- moves to localised pain
4- flex to withdraw from pain
3- abnormal flexion
2- abnormal extension
1- unresponsive
what should be done if GCS is 8/15 or below?
airway should be secured
what type of intracranial bleeds are spontaneous?
-intracerebral
-SAH
-haemorrhagic infarct
what type of intracranial bleeds are traumatic?
-subdural
-extradural
-contusion (surface bruising)
-intracerebral
-SAH
what is an extradural haematoma?
collection of blood between the dura and the skull
where does bleeding occur in extradural haematoma?
between the dura mater and the skull
what artery is ruptures in extradural haematoma?
middle meningeal artery
what fracture is associated with extradural haematoma?
temporal bone fracture
- Middle meningeal artery is located in temporo parietal region
- Pterion is weakest part of skull (where all the parts of skull join)
typical patient presenting with extradural haeatoma?
young patient with head trauma
presentation- extradural haematoma?
-On going headache
-N+V
-Decreased consciousness
-Confusion
-Unilateral fixed pupils, RAPD
-Period of improved neurological symptoms and consciousness (lucid period) followed by a rapid decline over hours
-Rapid decline as the haematoma gets large enough to compress the intracranial contents
investigations- extra dural haematoma?
Urgent CT
what is seen on CT of extradural haematoma?
-lens shape/ bi convex/ lemon shaped mass
treatment extradural haematoma?
urgent decompression surgery
where is blood found in a subdural haematoma?
between the dura and arachnoid mater
what vessel ruptures in subdural haematoma?
bridging veins (between dura mater and arachnoid mater)
who is more likely to get a subdural haematoma?
People with brain atrophy
-older patients
-alcoholics
are subdural haematomas unilateral or bilateral?
can be both
-more likely to be bilateral in children
presentation- subdural haematoma?
Slower onset of symptoms than epidural haematoma
* Fluctuating confusion/ consciousness
* Headaches
* N+V
* Neuro deficits
* Personality changes
* Incontinence
* Confusion
* Gait changes/ Hemiparesis
what can mass effect of subdural haematoma cause?
herniations
