Neurology - Bleeding Flashcards
SAH causes
ANEURYSM
- RF - HTN, PKD, AVM
Common places for aneurysm
- ACA and anterior communicating
- MCA bifurcation
- Posterior communicating and internal carotid
SAH presentation
Thunderclap headache Worst headache ever Sudden onset Meningism FND Vomiting CN3 palsy LOC Seizure Reduced GCS
SAH investigations
CT - STAR SHAPED LESION IN BASAL CISTERN
LP - Xanthochromia, protein
ECG - Long QT, ST elevation
Ophthalmoscopy
- Loss of light reflex
- Intraocular haemorrhage
SAH management
Endovascular coiling
Nimodipine - Reduces spasm
Ventriculoperitoneal shunt to reduce ICP
SAH complications
Re-bleed - 20% Vasospasm - Stroke Hyponatraemia Hydrocephalus Loss of sympathetic reflex - HTN
SDH causes
Tear in bridging veins
Alcoholics
Elderly - Anticoags
Shaken babies
SDH presentation
Previous head trauma - Up to 9 months LOC FND Headache Personality changes Change in GCS ^ ICP
SDH investigations
CT - Concave lesion
Midline shift - Not limited by suture lines
Bright on CT - New
Dark on CT - Old
SDH management
Burr holes
Craniotomy
Old - Conservative management unless symptoms
EDH causes
Head trauma - Pterion
Tearing of middle meningeal artery - 90%
Dural venous sinus - 10%
EDH presentation
Trauma - Lucid interval (hours) - Change in GCS Headache ^ ICP Brisk reflexes Upward plantars
Skull fracture
- Asymmetrical face
- CSF rhinorrhoea
EDH investigations
CT - Convex lesion - Does not cross suture lines
XR - Skull fracture
LP contraindicated
EDH management
Burr holes
^ ICP - Mannitol
Total anterior stroke
ACA
MCA
Presentation
- Unilateral weakness
- Homonymous hemianopia
- Higher cognitive disorder - Dysphasia?
Partial anterior stroke
Part of ACA or MCA
2 of…
- Unilateral weakness
- Homonymous hemianopia
- Higher cognitive disorder - Dysphasia?
Posterior stroke
Vertebrobasilar
Presentation
- LOC
- Isolated homonymous hemianopia
- Cerebellar disorder
- CN palsy
- Contralateral motor/sensory deficit
Lacunar stroke
Perforating arteries
Presentation
- Pure motor
- Pure sensory
- Ataxic hemiparesis
- Mixed sensory motor
ACA stroke
Hemiparesis
Sensory loss in LOWER
MCA stroke
Hemiparesis
Sensory loss in UPPER
Weber stroke
PCA
CN3
Contralateral hemiparesis
Wallenberg
PICA
Ipsilateral
- Sensory loss of pain
- Loss of gag reflex
- Hoarse voice
- Cerebellar signs
- Horner’s syndrome
Contralateral
- Sensory loss of pain
Lateral pontine syndrome
AICA
Ipsilateral
- Sensory loss of pain
- Loss of gag reflex
- Hoarse voice
- Cerebellar signs
- Horner’s syndrome
- FACIAL PARALYSIS
- DEAFNESS
Contralateral
- Sensory loss of pain
Locked in syndrome
Basilar
Unable to move except eyes and extra-ocular muscles
Wernicke’s aphasia
Receptive
Superior temporal gyrus
MCA
Sentences do not make sense
Speech fluent
Comprehension impaired
