Intracranial Haemorrhage Flashcards
(40 cards)
What is the presentation of an SAH?
sudden onset severe HA; collapse; vomiting; neck pain and photophobia
What do the N&V; neck pain and photophobia signify?
chemical meningitis due to blood in the subarachnoid space
What is the differential dignosis of sudden onset HA?
SAH; migraine; benign coital cephalgia
What is benign coital cephalgia?
HA onset after orgasm
How is benign coital cephalgia diagnosed?
diagnosis of exclusion
Why is benign coital cephalgia a diagnosis of exclusion?
SAH can also present after orgasm
What is the most common cranial nerve to be involved in SAH?
CNIII
What may be seen on fundoscopy in SAH?
retinal or vitreous haemorrhage
What imaging is used for SAH?
CT
How many patients have a negative CT with SAH?
15%
What ix should be done in a patient with suspected SAH with negative CT?
LP
When is an LP safe?
in alert patients with no focal neuro deficit and no signs of increased ICP or after normal CT scan
How long hsould you wait before doing an LP with SAH?
6-48hours
What would you expect to see with an LP in SAH?
xanthochromic CSF
What is xanthochromic CSF?
yellow CSF due to the breakdown products of blood
What artery is used for cerebral angiography?
femoral
Why may cerebral angiography miss an aneurysm?
vasospasm
What are the complications of SAH?
re-bleeding; delayed ischaemic deficit; hydrocephalus; hyponatraemia; seizures
How is rebleeding stopped?
endovascular techniques putting coils into the aneurysm
When is delayed ischaemic neuro deficit seen?
days 3-12
What causes delayed ischamia?
vasospasm
what medication is given to try and prevent vasospasm?
nimodipine
What therapy is give nafter SAH to prevent delayed ischaemia?
triple H therapy- hypertension; hypervolaemia and haemodilution
What are the signs of delayed ischaemia?
altered consicous level or focal deficit
