CT and MRI , ECG changes , found in Subarachnoid and Intracerebral hemorrhage.

2. POINTS OF FOCUS :
• CT – SAH AND ICH
• MRI – SAH AND ICH
• FUNDUS EXAMINATION IN SAH
• ECG FINDINGS IN ICH

5. SAH•Subarachnoid hemorrhage is bleeding into the space in
between the first membrane covering the brain (pia matar)
and the second membrane (meninges) covering the brain
(arachnoid mater).
•The subarachnoid cavity contains a sponge like tissue made
up of trabeculae and interconnecting channels which
communicateand contain cerebrospinal fluid.
Description
•Sudden onset of a severe headache (often described as "the
worst headache of my life")
•nausea and vomiting
•stiff neck
•sensitivity to light (photophobia)
•blurred or double vision
•loss of consciousness
•seizures
Signs and symptoms
•Aneurysm ,a balloon-like bulge or weakening of an artery wall
that ruptures, releasing blood into the subarachnoid space
around the brain.
•AVM, an abnormal tangle of arteries and veins with no
capillaries in between. The weakened blood vessels can
rupture and bleed.
•Head trauma
Causes
•CT /CTA
•LP
•Angiogram
•MRI
Diagnostic tests
•Resuscitate, Admit
•Surgical clipping
•Endovascular coiling
•Nimodipine, Transcranial doppler (TCD) ultrasounds –
vasospasm
• Triple H Therapy-Hypertension:involves increasing the
blood pressure to force blood through the narrowed
arteries.
•Hypervolemia:involves increasing IV fluids to make more
blood volume.
•Hemodilution:involves making the blood thin and watery so
that it flows more easily through narrowed arteries.
•a lumbar drain /ventricular drain,
Treatment
•For 10 to 14 days following SAH, the patient will remain in the
neuroscience intensive care unit , where there is close
watch for signs of renewed bleeding, vasospasm,
hydrocephalus, and other potential complications.
Complications

6. CT – SAH(NON CONTRAST )
The extent and location of sub arachnoid blood on non contrast CT scan
help :
1. Locate the underlying aneurysm
2. Identify the cause of neurologic deficit
3. Predict delayed vasospasm
More than 95 % of cases have enough blood to be visualized on high
quality non contrast CT obtained within first 72 hours.

7. • EXACT SITE OF OFFENDING ANEURYSM CAN BE INFERRED FROM THE LOCATION OF THE MAIN CLOT. EG. IF
THERE IS COLLECTION OF BLOOD IN:
- ANTERIOR INTER HEMISPHERIC FISSURE : RUPTURE OF ANT. COMMUNICATING ARTERY
- SYLVIAN FISSURE – MIDDLE CEREBRAL ARTERY
- ANTERIOR PERIMESECEPHALIC CISTERN – POST. COMMUNICATING ARTERY OR DISTAL BASILAR ARTERY

9. Sub-hyaloid hemorrhageon fundoscopy .
Boat shaped
,between
posterior layer of
vitreous and
retina
Terson’s syndrome
rapid increase in ICP
associated with
hemmorage – worse
outcome
Highly
suggestive
of SAH (11 to
33%)
Treatment is YAG laser .

11. • MRI IS SENSITIVE TO SUBARACHNOID BLOOD AND IS ABLE TO VISUALIZE IT WELL IN THE FIRST 12 HOURS TYPICALLY AS A
HYPERINTENSITY IN SUBARACHNOID SPACE ON FLAIR .
• FLUID-ATTENUATED INVERSION RECOVERY (FLAIR) IS AN MRI SEQUENCE WITH AN INVERSION RECOVERY SET THO NULL
FLUIDS. FOR EXAMPLE, IT CAN BE USED IN BRAIN IMAGING TO SUPPRESS CEREBROSPINAL FLUID (CSF) EFFECTS ON THE
IMAGE,

12. ECG CHANGES IN SAH
• ECG USUALLY SHOWS ST SEGMENT AND T WAVE CHANGES
• SIMILAR TO THOSE IN CARDIAC ISCHEMIA
1. PROLONGED QRS
2. INCREASED T INTERVAL
3. PROMINENT PEAKED OR DEEPLY INVERTED SYMMETRIC T WAVES

13. ICH•Intracerebralhemorrhage (ICH) is a type of stroke caused by bleeding
within the brain tissue itself
Description
•headache, nausea, and vomiting
•lethargy or confusion
•sudden weakness or numbness of the face, arm or leg, usually on one
side
•loss of consciousness
•temporary loss of vision
•seizures
Signs and symptoms
•Hypertension:an elevation of blood pressure that may cause tiny
arteries to burst inside the brain.
•Bloodthinnertherapy:drugs such as coumadin, heparin, and warfarin
used to treat heart and stroke conditions.
•AVM:a tangle of abnormal arteries and veins with no capillaries in
between.
•Aneurysm:a bulge or weakening of an arterial wall.
•Headtrauma: fracturesto the skull and penetrating wounds (gunshot)
can damage an artery and cause bleeding.
•Bleedingdisorders:hemophilia, sickle cell anemia, DIC,
thrombocytopenia.
•Tumors: highlyvascular tumors such as angiomas and metastatic
tumors can bleed into the brain tissue.
•Amyloid angiopathy:a degenerative disease of the arteries.
•Drugusage:cocaine and other illicit drugs can cause ICH.
•Spontaneous:ICH by unknown causes.
Causes
• CT /CTA
• Angiogram
• Magnetic resonance imaging (MRI).
Diagnostic tests
• Patients with small hemorrhages (<10 cm3) -
medically.
Cerebellar hemorrhages (>3 cm3),
deteriorating , brainstem compression
,hydrocephalus are treated surgically to
remove the hematoma as soon as possible
Patients with large lobar hemorrhages (50
cm3) ,deteriorating usually undergo surgical
removal of the hematoma.
• ICP monitor
• Craniotomy
• Stereotactic aspiration-large hematomas
Treatment

14. CT NON CONTRAST , ICH

16. MRI , ICH

17. ECG IN ICH
• IN ELECTROCARDIOGRAPHY, A STRAIN PATTERN IS A WELL-RECOGNIZED MARKER FOR THE PRESENCE OF
ANATOMIC LEFT VENTRICULAR HYPERTROPHY (LVH) IN THE FORM OF ST DEPRESSION AND T WAVE
INVERSION ON A RESTING ECG.

18. REFERENCES :
1. HTTPS://RADIOPAEDIA.ORG/ARTICLES - CT ,MRI
2. GOOGLE IMAGES – ECG
3. WASHINGTON MANUAL , PAGE NUMBER 959 , 960

19. THANKYOU 