Intracranial Haemorrhage

Question 1

Name the 3 types of spontaneous intracranial haemorrhage?

Answer 1

subarachnoid haemorrhage
intracerberal haemorrhage
intraventricular haemorrhage

Question 2

Subarachnoid haemorrhage

• what is it?
• normally underlying what?
• presentation? (6)
• what is the Ddx?
• signs? (5)
• inv? (3)
• complications? (5) & management of these

Answer 2

• bleeding into the subarachnoid space
• berry aneurysm

-sudden onset severe headache 
collapse
vomiting
neck pain
photophobia 

-migraine & benign coital cephalgia

-neck stiffness
photophobia
decreased conscious level 
focal neurological deficit 
fundoscopy shows retinal or vitreous haemorrhage 

-CT 
brain, less good if presenting late 
LP 
safe if no focal neurological deficit and no papilloedema, wait 12 hours then see xanthochromic CSF
Cerebral angiography 
can see any aneurysms 

-Re-bleeding
(often fatal, need surgical clipping)
Delayed ishcaemic deficit
(occurs days 3-12, get altered conscious level or focal deficit, give amlodipiene & triple H)
Hydrocephalus
(increased intracranial CSF pressure, get inc headache, often transient, CSF drainage & shunt)
hyponatreamia
(SIADH, often transient, supplement Na, fludrocortisone if necessary)
seizures

Question 3

Intracerebral haemorrhage

• what is it?
• causes? (3)
• presentation
• inv?
• treatment?

Answer 3

• bleeding into the brain parenchyma
• 50% due to hypertension, 30% due to aneurysm or AVM

-headache
focal neurological deficit
decreased conscious level

-CT- urgent of dec consciousness
Angiography
if AVM suspicion

-surgical evaluation of haematoma +/- treatment of underlying abnormality
non surgical

Question 4

Intraventricular haemorrhage

-what is it?

Answer 4

-occurs with a rupture of a subarachnoid or intracerebral bleed into the ventricle

Question 5

Arteriovenous malformations

• what are they?
• what is steal syndrome?
• treatment? (4)

Answer 5

-arteriovenous shunts, normally congenital
normally intraparenchymal

-ischaemia as a result of a fistula

-surgery 
Endovascular embolisation 
stereotactic radiotherapy
conservative 
Weigh risks against benefit