Intracranial haemorrhages

Question 1

What are the 2 categories

Answer 1

Spontaneous

Traumatic

Question 2

Name the 3 spontaneous intracranial haemorrhages

Answer 2

Intracerebral haemorrhage
Subarachnoid haemorrhage
Haemorrhagic infarct

Question 3

Name 5 traumatic intracranial haemorrhages / haematomas

Answer 3

Extra-dural haematoma 
Sub-dural haematom
Contusion
Intracerebral haemorrhage 
Sub-arachnoid haemorrhage

Question 4

Subarachnoid haemorrhage - definition

Answer 4

Bleeding into the subarachnoid space

Question 5

Subarachnoid haemorrhage - why does bleeding occur in the subarachnoid space?

Answer 5

This is where the major arterial supply of the brain is located

Question 6

Subarachnoid haemorrhage - 2 categories of causes

Answer 6

Traumatic

Non-traumatic

Question 7

Subarachnoid haemorrhage - traumatic causes are more common than non-traumatic causes. true or false?

Answer 7

True

Question 8

Subarachnoid haemorrhage - give an example of a non-traumatic cause

Answer 8

Berry aneurysm rupture

- mostly occurs in the territory of the internal carotid artery

Question 9

Where do berry aneurysms tend to form?

Answer 9

At the site where the arteries of the circle of willis branch

Question 10

Subarachnoid haemorrhage - name 3 risk factors

Answer 10

Smoking
Hypertension
PKD (berry aneurysms)

Question 11

Subarachnoid haemorrhage - more common in men/women

Answer 11

Women

Question 12

Subarachnoid haemorrhage - most occur before/after the age of 50

Answer 12

before

Question 13

Subarachnoid haemorrhage - onset

Answer 13

Abrupt

Sudden onset

Question 14

Subarachnoid haemorrhage - clinical features

Answer 14

Sudden onset severe headache (thunderclap headache)
- headache takes less than 5 mins to reach its peak

Collapse
Vomiting
Neck pain
Photophobia

Question 15

Subarachnoid haemorrhage - clinical signs

Answer 15

Neck stiffness
Photophobia
Global neurological deficit (decreased conscious level) 
Focal neurological deficit 
- Dysphasia, hemiparesis, CNIII palsy

Question 16

Subarachnoid haemorrhage - which imaging investigation is first line?

Answer 16

CT scan

Question 17

Which imaging investigation is usually accurate in picking up an acute bleed?

Answer 17

CT scan

Question 18

What does fresh blood look like on a CT scan?

Answer 18

Highly dense -> looks white on CT scan

Question 19

What does CSF look like on a CT scan

Answer 19

Black

Question 20

If a CT scan identifies a subarachnoid haemorrhage then what is the next step?

Answer 20

There are no further investigations required

Question 21

If a CT scan comes back negative then what is the next step?

Answer 21

Lumbar puncture

Question 22

A lumbar puncture is safe to carry out after a normal CT scan. True or false?

Answer 22

True

Question 23

If the patient has a -ve CT scan but gets a lumbar puncture, what features of LP suggest the patient has had a sub-arachnoid haemorrhage

Answer 23

Blood visible in CSF

Sometimes there are just blood breakdown products in the CSF that appear yellow

Question 24

Why is it important to take 3 separate CSF samples when carrying out lumbar puncture?

Answer 24

If bottle 1 has lots of blood but bottle 3 has much less blood, then this is a traumatic tap and is NOT a subarachnoid haemorrhage

Question 25

What is the gold standard investigation to find a berry aneurysm?

Answer 25

Cerebral angiography

Question 26

Subarachnoid haemorrhage - initial management

Answer 26

``` Mannitol - to lower ICP Bed rest Analgesia Anti-emetic IV fluids ```

Question 27

Give 2 methods to treat aneurysms

Answer 27

Endovascular technique - fill aneurysm with coils so that no more blood can get in Surgical clipping

Question 28

Subarachnoid haemorrhage - complications

Answer 28

``` Re-bleeding Delayed ischaemia Hydrocephalus Hyponatraemia Seizures ```

Question 29

Benign coital cephalgia is related to ?

Answer 29

Having sex

Question 30

Intracerebral haemorrhage - definition

Answer 30

Bleeding into the brain parenchyma

Question 31

Intracerebral haemorrhage - causes

Answer 31

Secondary to hypertension Aneurysm Anticoagulation

Question 32

Intracerebral haemorrhage - most common location

Answer 32

Basal ganglia

Question 33

Intracerebral haemorrhage - morphology on cut surface of brain

Answer 33

Asymmetrical distortion of brain Various shifts and herniations Well demarcated intra-parenchymal haematomas Surrounding oedema

Question 34

Intracerebral haemorrhage - clinical features

Answer 34

Headache Focal neurological deficit Decreased conscious level

Question 35

Intracerebral haemorrhage - first line investigation

Answer 35

CT scan

Question 36

Intracerebral haemorrhage - mangement - indications for surgical management

Answer 36

If the patient has decreased conscious level

Question 37

Intracerebral haemorrhage - indication for non-surgical management

Answer 37

Conscious

Question 38

Intraventricular haemorrhage - definition

Answer 38

Blood in the ventricles

Question 39

Extradural haemorrhage - location

Answer 39

Between the bone and dura

Question 40

Which artery is located between the bone and dura and therefore must be ruptured in an extradural haemorrhage?

Answer 40

Middle meningeal artery

Question 41

Extradural haemorrhage - occurs due tu rupture of ??

Answer 41

Pterion

Question 42

Sub dural haemorrhage - definition

Answer 42

Collections of blood between the internal surface of the dura and arachnoid mater

Question 43

What crosses the subarachnoid space between arachnoid and dura mater?

Answer 43

Cerebral veins

Question 44

What is ruptured in a subdural haemorrhage ?

Answer 44

Cerebral veins

Question 45

Sub dural haemorrhage - how does it occur?

Answer 45

Falls in the elderly | Alcoholics

Question 46

Which type of haematoma is most common? intradural/extradural/subdural

Answer 46

Intradural

Question 47

Extradural haematomas enlarge quickly/slowly?

Answer 47

Quickly

Question 48

Acute subdural haematoma

Answer 48

Clear history of trauma | Swelling of cerebrum on side of haematoma

Question 49

Acute subdural haematoma is common in young/elderly patients

Answer 49

Elderly

Question 50

Elderly patient on anti platelet medication falls and there is minor head trauma. what is the likely diagnosis?

Answer 50

Subdural haematoma

Question 51

Young man playing rugby and has a head strike. Initially loses consciousness -> lucid interval -> deterioration. What’s the likely diagnosis

Answer 51

Extradural haematology