What are the main subtypes of a spontaneous intracranial haemorrhage
Subarachnoid
Intracerebral
Intraventricular
What is a subarachnois haemorrhage
Bleeding into the subarachnoid space
What is the prognosis of a subarachnoid
Potentially fatal
45 percent 30 day mortality rate
What is the main underlying cause of a subarachnoid
Berry aneurysm
Arteriovenous malformation
idiopathic- no cause
trauma
How does SAH present?
Sudden onset severe headache- 'thungerclap' Collapse Vomiting Neck pain Photophobia
What signs are present in SAH
Neck stiffness
Photophobia
Decrease consciousness
Focal neurological deficit- dysphasia, hemiparesis, third nerve palsy
What can be seen on fundoscopy of a SAH
retinal or vitreous haemorrhage
What does a third nerve palsy look like clinically
Eye position is down and out due to now unopposed lateral rectus and SO muscles
Lid pstosis - due to levator palperbrae superioris
Blown out pupil- as CN 3 innevates the sphinter pupillae muscles
What are the down sides to CT in imaging a SAH
can be negatice if more than 3 days post ictus
can be falsely negative in up to 15 percent of pts
When is a lumbar puncture safe?
in alert pts with no focal neuro deficit, no papilloaedaema or after normal CT
What will be the features of the CSF in someone who has had a SAH
bloodstained
xanthochromic
What is the seldinger technique
The Seldinger technique, also known as Seldinger wire technique, is a medical procedure to obtain safe access to blood vessels and other hollow organs
Where is the guidewire initially inserteted when performing cerebral angiography
femoral artery
What is the gold standard inverstigation for a SAH
cerebral angiography
Name some complications of a SAH
re bleeding delayed ischaemic deficit hydrocephalus hypnatraemia seizures
What are the risks of re bleeding
often fatal
20 percent risk in first 14 days
50 percent risk in first 6 mths
When does DIND usually occur
day 3-12
what is vasospasm
Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction
how can vasospasm be prevented
Nimodipine - calcium channel blocker
What is the principle method of treatment for DIND due to vasospasm
High fluid intake ie Triple H therapy
- hypertension
- hypervolaemia
- hemidilution
What is hydrocephalusq
increase intracranial CSF
How is hydrocephalus treated?
CSF drainage by
- lumbar puncture
- shunt
- external ventricular drainage
What is SIADH
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive release of antidiuretic hormone from the posterior pituitary gland or another source. The increase in blood volume (hypervolemia) often results in dilutional hyponatremia in which the plasma sodium levels are lowered and total body fluid is increased
How is SIADH treat in the context of a SAH
do not fluid restrict
Supplement sodium Treat with fludrocortisone
What is the risk of siezures post SAH
3 percent acutely
10 percent five year risk
What is an intracerebral haemorrhage
Bleeding into the brain parenchyma
What is the main cause of intracerebral haemorrhage
Hypertension - half of cases
Aneurysm
AVM
What is a charcot bouchard aneurysm
aneurysms of the brain vasculature which occur in small blood vessels (less than 300 micrometre diameter
-common cause of ICH
How can ICH present
headache
FND
decreased consciousness
What investigations are used in ICH
CT scan urgently
Angiography is suspected vascular anomaly
What is an intraventricular haemorrhage
A bleed into the ventricles due to a rupture of a subarachnoid or intracerebral bleed into the ventricle
what is steal syndrome
a constellation of signs and symptoms that arise from retrograde (reversed) flow of blood in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery.
