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Hemorrhagic stroke. Inspired by the MLA content map presented by Warwick Medical School Radiology Society. In association with Ir Juniors subarachnoid hemorrhage presentation. A 60 year old male attends with a sudden onset of a severe headache in the back of his head. More severe than any headache. He has had previously described as a thunderclap headache. He has also been vomiting and cannot look at bright lights, examination findings positive chronic sign subarachnoid hemorrhage, bleeding into the subarachnoid space on the brain between the arachnoid mater and the pia mater pathophysiology. Bleeding into the subarachnoid space can occur following trauma example, a road traffic accident or fall or spontaneously following a ruptured aneurysm or arterial venous malformation, subarachnoid hemorrhage is caused by bleeding from a cerebral artery risk factors, hypertension, smoking, family history, autosomal dominant polycystic kidney disease age over 50 years. Female sex investigations, laboratory investigations, full blood count using these coagulation studies prior to lumbar puncture or surgery. Imaging, plain CT and CT angiography, lumbar puncture only if subarachnoid hemorrhage suspected but ct inconclusive to be completed at least 12 hours following symptom onset management. ABCD E assessment to identify urgent problems and stabilize patient neurosurgical referral most intracranial aneurysms are now treated with a coil by interventional neuroradiologist. But a minority require a craniotomy and clipping by a neurosurgeon. Until the aneurysm is treated. BP control calcium channel blockers must be given to reduce cerebral artery spasm and secondary cerebral ischemia. Prognosis depends on cause and severity. Approximately 50% of patients die immediately or soon after subarachnoid hemorrhage, subdural hemorrhage presentation. 80 year old female with a background of dementia presents with her carer who states she has been a lot more confused lately or vomiting and has been complaining of a severe headache, subdural hemorrhage collection of blood located between the dura and arachnoid mater pathophysiology. Subdural hemorrhage is caused by rupture of the bridging veins in the outermost meningeal layer, most commonly around the frontal and parietal lobes. Risk factors. Recent trauma, coagulopathy, advancing age over 65 years, alcoholism, history of coagulopathy, key diagnostic factors, trauma, headache, nausea and vomiting, diminished eye verbal motor response, confusion investigations, first line non contrast ct scan showing crescent shaped collection of blood. Second line MRI management A to e assessment, reversible of coagulations, prophylactic anti epileptics, conservative management if bleed is small with minimal mass effect surgical management if large bleed trauma, uh craniotomy to evacuate blood and reduce intracranial pressure. The whole craniotomy used for management of chronic subdural hemorrhage, complications of subdural hemorrhage, permanent neurological deficits, coma, severe seizures, intracranial infection, extradural hematoma presentation. 30 year old male falls from a height of 3 m. He briefly loses consciousness after the accident but comes around quickly. He complains of a headache and has a contusion on the right temporal parietal region. He is taken to A&E via ambulance. A couple of hours later, he begins to deteriorate, feeling a tingling sensation in his legs and G CS is reduced. An axial head. CT shows an extradural bleed, midline shift with compression of lateral ventricles and soft tissue swelling over the fracture site. An axial bone window shows a fracture. Patient is taken to theater for a trauma, craniotomy to reduce intracranial pressure and drain the hematoma hemorrhage collection of blood in the space between the periosteal layer of the dura mater and the inner surface of the skull. Pathophysiology, rupture of artery or vein in the extradural space leads to collection of blood which forces the dura mater away from the skull leading to a biconvex shaped hematoma. Since they are generally limited by cranial sutures, the middle meningeal artery is particularly at risk of causing an extradural hemorrhage as it lies beneath the pterion. A point of weakness where four bones of the skull fuse. If the hematoma increases in size, it can increase intracranial pressure which can damage brain tissue or cause herniation through the atorium. Cerebelli risk factors, trauma, particularly in the temporoparietal region. Fall sports injury, road traffic accidents, all can lead to this arteriovenous malformations and coagulopathies, signs and symptoms, headache, nausea, and vomiting confusion. Although there may be an initial loss of consciousness. With trauma, patients will regain normal levels followed by a gradual loss of consciousness hours after initial injury, cranial nerve deficits, motor or sensory changes to limbs. Cushing's triad of intracranial, raised intracranial pressure, bradycardia, widened pulse pressure, irregular respiration, examinations, neurological examination, upper and lower limbs and cranial nerves investigations. First line is non contrast CT scan showing a biconvex shaped hematoma, midline shift and herniation with larger bleeds. Other options include MRI. However, this takes longer and is more expensive and angiography which may show arteriovenous malformations, management, medical management at e assessment, reversible of anticoagulations, treatment of coagulopathies, prophylactic antibiotics for trauma and reduce intracranial pressure. Example, Mannitol surgical management, if smaller bleed, a conservative approach is employed if a larger bleed bur hole or trauma, craniotomy to allow drainage, reduce intracranial pressure and treat cause of bleed hemicraniectomy is to prevent any mass effect and herniation. Although no first line treatment, the role of endovascular intervention in middle meningeal artery bleeds has recently been researched, cranial slash cerebral aneurysms, intracranial or cerebral aneurysms are focal abnormal dilatations or out pouchings of the intracranial arteries which present sites of weakness, prone to rupture, risk of rupture is proportional to the size of the aneurysm and upon rupture result, subarachnoid hemorrhage pathophysiology. A cerebral aneurysm and its complications. Rupture involve structural changes in the arterial wall. Exact pathogenesis remains unknown but key components in aneurysm formation, growth and rupture include ECM defects and degeneration, hemodynamic stress and inflammatory responses. Risk factors. Age there is a bimodal distribution, comorbidities, ethnicity, anxiety, hypertension, smoking, presence of subarachnoid hemorrhage size and location of aneurysm risk of intracranial aneurysm rupture can be calculated with the phases risk prediction score which stands for population hypertension age size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm size of aneurysm signs and symptoms largely a symptomatic until point of rupture. Rare symptoms include uh of an unruptured brain aneurysm can include visual disturbances, numbness or weakness on one side of the face. Headaches, dysphasia, symptoms of rupture include spontaneous acute headache, blinding pain, nausea, photophobia, diplopia, loss of consciousness fits seizures and weakness on one side of the body or limbs. Examinations, upper and lower limb neuro exams, cranial nerves, investigations. First line would be an X ray or ct angiography or magnetic resonance angiography to consider lumbar puncture indicated if CT negative but suspicion persists. And a ct head management decision to treat should be determined by patient and aneurysm specific factors, unruptured aneurysm prophylactic treatment usually only recommended of high risk. Otherwise, lifestyle changes targeting risk factors include smoking cessation and addressing hypertension. And if ruptured, treat as per subarach hemorrhage, treatment of unruptured coexistent aneurysms should also be considered intracranial aneurysm right side, large cavernous sinus aneurysm, ruptured intracranial aneurysm aneurysm of are right ICA subacute hematoma. In right frontal lobe, compressing right, frontal lobe and right lateral ventricle causing left sided shift, diagnostic arteriography and showing the treatment after resources. Thank you.
