Intracranial Haemorrhage

Question 1

what is a intracranial venous thrombosis

Answer 1

a venous infarction that can develop in any of the dural venous sinuses

Question 2

what are the risk factors for developing intracranial venous thrombosis

Answer 2

pregnancy
COCP, transexamic acid use 
dehydration 
malignancy 
head injury

Question 3

how does a sagittal sinus thrombosis present

Answer 3

headache 
vomiting
seizures 
reduced vision
papilloedema

Question 4

how does a transverse sinus thrombosis present

Answer 4

headache
mastoid pain
focal seizures
papilloedema

Question 5

what structures pass through the cavernous sinus

Answer 5

CN 3, 4, 5 (1/2) and 6
internal carotid
sympathetic fibres

Question 6

what is the most likely cause of cavernous sinus thrombosis

Answer 6

infection spread from the face

Question 7

how does cavernous sinus thrombosis present

Answer 7

ophthalmoplegia 
ptosis
fever
focal neurology
raised ICP

Question 8

how is a sinus thrombosis managed

Answer 8

anticoagulation such as heparin, warfarin or streptokinase

manage symptoms of raised ICP

Question 9

what does a subarachnoid haemorrhage bleed into

Answer 9

the subarachnoid space between the dura and pia mater

Question 10

what is the most common cause of SAH and what conditions predispose to this

Answer 10

rupture of berry aneurysm

conditions such as PKD, Enhler Danlos and coarctation of the aorta predispose to this

Question 11

other than rupture of berry aneurysm, what else causes SAH

Answer 11

arteriovenous malformation

vasculitis

Question 12

bifurcation of cerebral arteries is a common site for which intracranial bleed

Answer 12

SAH

Question 13

describe the headache felt in SAH

Answer 13

sudden onset, worst ever headache - thunderclap

can occur when lifting heavy objects or having sex

Question 14

what are the other clinical features of SAH

Answer 14

collapse
decreased or loss of consciousness
meningism - photophobia and neck stiffness
3rd nerve palsy

Question 15

what is the first line investigation for suspected SAH

Answer 15

CT but sensitivity reduces over time, shows grey areas within normally dark ventricles

Question 16

what are the lumbar puncture findings of SAH

Answer 16

xanthochromic CSF - turns yellow due to breakdown of RBCs but takes at least 6 hours to develop

Question 17

what is the acute management of SAH

Answer 17

maintain cerebral perfusion by inducing hypertension with IV saline

Question 18

what drug can help with SAH and why

Answer 18

nimodipine, CCB that reduces the chance of cerebral artery spasm and ischaemia

Question 19

what is the surgical management for SAH

Answer 19

aneurysm clipping and repair

Question 20

what is the main complications of SAH

Answer 20

re-bleeding, often fatal
delayed ischaemia
hydrocephalus
hyponatraemia - manage with sodium supplements

Question 21

is a subdural haemorrhage venous or arterial blood

Answer 21

venous

Question 22

where does a subdural haemorrhage occur

Answer 22

in the bridging veins connecting the dural venous sinuses

blood accumulates between the dura and arachnoid mater

Question 23

what are the main risk factors for developing a subdural haemorrhage

Answer 23

increased age
alcoholism
epilepsy
anti-coags

Question 24

what events usually leads up to a subdural haemorrhage

Answer 24

usually in the context of low impact trauma that the individual sometimes cannot remember

Question 25

how does a subdural haemorrhage present

Answer 25

``` fluctuations in consciousness sleepiness dull headache unsteadiness focal neurology onset of symptoms is slow and insidious ```

Question 26

what are the CT findings seen in a subdural haemorrhage

Answer 26

crescent/sickle shaped haematoma not confined to the cranial suture lines features of midline shift also seen

Question 27

how is a subdural haemorrhage managed

Answer 27

prophylactic anti-epileptics | surgery if expanding haematoma, burr hole craniotomy or craniotomy

Question 28

where does the bleed arise in an epidural haemorrhage

Answer 28

usually middle meningeal artery

Question 29

where does blood pool in an epidural haemorrhage

Answer 29

between the dura and the temporal bone

Question 30

a young person presenting with recent temporal bone fracture/trauma most likely has what

Answer 30

epidural haemorrhage

Question 31

how does an epidural haemorrhage present

Answer 31

head injury followed by lucid period increasingly severe headache then sudden decline in consciousness + confusion, seizures, vomiting, hemiparesis, focal neurology and signs of raised ICP

Question 32

what are the CT findings of an epidural haematoma

Answer 32

lemon/lens/biconvex haemorrhage that is confined to cranial sutures

Question 33

how is an epidural haemorrhage managed

Answer 33

stabilise and transfer to neurosurgical unit for clot stabilisation and ligation of middle meningeal artery