20. Diagnosis, treatment and prognosis of subarachnoid hemorrhage (SAH)

Question 1

Define subarachnoid space

Answer 1

Between the arachnoid mater externally and pia mater internally

Question 2

Etiology of SAH

Answer 2

• Aneurysms (75%)
• Perimesencephalic hemorrhage (10%)
• A-V malformations (5%)

but a lot of investegations fail to reveal the source

Question 3

Signs and symptoms of SAH

Answer 3

• Severe headache
• Loss of conciousness, coma
• Epileptic seizure
• Nausea, vomit
• Neck stiffness
• Focal signs (limb weakness, dysphasia)
• Reactive hypertension
• Pyrexia

Question 4

Diagnosis of SAH

Answer 4

• Acute CT
• Lumbar puncture
• MRI
• CT/MR angio

Question 5

Managament of SAH

Answer 5

• Monitor CNS (bp, pupils, gcs)
• Hydrate (to maintain cerebral perfusion)
• Nimodipine (prevent vasospasm)
• Surgery within 48h, if not then a dealyed (after 14d)

Question 6

Surgical treatment of SAH

Answer 6

Withing 48h, if not then after 14 days. Endovascular coiling or surgical clipping. Balloon modeling and flow diersion are newer techniques.

Question 7

Prognosis of SAH

Answer 7

Depends on grade. Grade 0(no signs) = 0% mortality, Grade V (coma) = 100% mortality. Most motality occur in 1st month.

Question 8

When is the lumbar puncture done in SAH?

Answer 8

over 12h after onset of headache. It allows breakdwn of RBCs and then the positive sample is yellow (due to bilirubin)