Intracranial Haemorrhage Flashcards
(29 cards)
What are the causes of Intracranial haemorrhage?
- Trauma
- Hypertension
- Vascular Malformations
- Cerebral aneurysm
- Arteriovenous malformation
- Cavernous haemangioma - Infection
- Intracranial tumours
- Bleeding disorders
- Drugs
- Iatrogenic
- Others
- Amyloidangiiopathy
- Granulomas
What are the clinical features of intracerebral haemorrhage?
Increased intracranial pressure
Focal neurological defict
What is the clinical features of increased intracranial pressure?
Headache
Nausea and vomiting
Blurred vision
Decreased level of consciousness
What is the clinical features of focal neurological deficit?
- Motor hemiparesis/ plegia
- Sensory deficit
- Cranial nerve deficit
- Balance and co-ordination
- Speech and language
How should you manage ICH?
Initial evaluation
Measures to prevent further rise in ICP
Treatment of raised ICP
Medical vs. surgical
What should be involved with you initial evaluation of ICH?
Evaluation and stabilise vital signs and protect airway
Biochemistry and haematological tests
CT brain
What are the measures to prevent further rise in ICP?
Control hypertension
Treat seizures
What is the location of an extradural haemorrhage?
Is it more likely to be traumatic or spontaneous?
Between bone and dura
Traumatic
What is the location of a subdural haemorrhage?
Is it more likely to be traumatic or spontaneous?
Between dura and arachnoid
Traumatic
What is the location of a subarachnoid haemorrhage?
Is it more likely to be traumatic or spontaneous?
Bellow the arachnoid
Both
What is the location of an intracerebral haemorrhage?
Is it more likely to be traumatic or spontaneous?
Inside the brain tissue
Spontaneous
What is the location of an intraventricular haemorrhage?
Is it more likely to be traumatic or spontaneous?
Inside the ventricles
Spontaneous
What is the mean age of presentation of SAH from intracranial aneurysm?
50 years
Sub arachnoid haemorrhage is more common in which sex?
Female
In younger people SAH is associated with what?
Polycystic Kidney Disease
Coarctation of the aorta
Marfan’s syndrome
Ehler-Danlos Syndrome
Familial
What are the clinical features of an aneurysmal SAH?
- Sudden severe headache
- Nausea and vomiting
- Photophobia
- Meningism- Neck pain
- Decreased level of consciousness
- Focal neurological deficit
- Seizures
What are the investigations for aneurysmal SAH?
CT
LP if CT is negative
Cerebral Angiography
Biochemistry
-U and Es
Haematology
-HB, WBC and clotting
How do you distinguish between traumatic and spontaneous SAH?
Clinical history - Trauma OR sudden headache
Radiological features- Blood in the convexities VS blood inside basal cisterns/ deep sulci
What is the medical management of aneurysmal SAH?
-Bed rest
-Adequate analgesics
-Anti-emetics
-Nimodipine
-Stool softeners
-Ted stockings
-Fluid administration
(Triple H - Hypertension, Hypervolemia, Hyperdilution)
What is the definitive treatment of aneurysmal SAH?
Endovascular embolisation
Surgical clipping
Give an intro to arteriovenous malformation
Congenital
Arteries flow straight into veins (no transition from capillaries)
Clinical symptoms in the second and third decades of life
Male = female
What are the clinical features of arteriovenous malformation?
Intracranial haemorrhage
Seizures
Focal neurological deficit
Haedache
Impaired higher cortical function
Bruit
What investigations do you perform in arteriovenous malformation?
CT
MR
Angiography
What is the treatment for arteriovenous malformation?
Endovascular embolisation
Stereotactic radiosurgery
Surgical excision
