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A - MSRA Neuro and Stroke [12] > [20] Subarachnoid Haemorrhage > Flashcards

[20] Subarachnoid Haemorrhage Flashcards

1
Q

What is a subarachnoid haemorrhage?

A

Bleeding into the subarachnoid space

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2
Q

What is the subarachnoid space?

A

The area between the arachnoid membrane and the pia mater surrounding the brain

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3
Q

What are subarachnoid haemorrhages usually a result of?

A

Bleeding from a berry aneurysm in the Circle of Willis

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4
Q

What percent of the population are berry aneurysms present in?

A

4%

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5
Q

Do most berry aneurysms rupture?

A

No

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6
Q

What causes development of berry aneurysms?

A

Susceptibility of the elastic lamina to stressors such as hypertension and atherosclerosis

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7
Q

What is another less common cause of subarachnoid haemorrhage?

A

Trauma

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8
Q

What are the risk factors for subarachnoid haemorrhage?

A
  • Hypertension
  • Smoking
  • Excessive alcohol consumption
  • Cocaine use
  • Genetic disorders
  • Family history
  • Age between 45-70
  • Female gender
  • Black ethnicity
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9
Q

What genetic disorders can predispose to subarachnoid haemorrhage?

A
  • Adult polycystic disease
  • Ehlers-Danlos Syndrome
  • Neurofibromatosis
  • Marfan’s Syndrome
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10
Q

Why might black ethnicity be a risk factor for subarachnoid haemorrhage?

A

They are at increased risk of hypertension

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11
Q

What is the most characteristic feature of a subarachnoid haemorrhage?

A

Sudden explosive headache

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12
Q

What is the sudden explosive headache of subarachnoid haemorrhage also known as?

A

Thunder clap headache

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13
Q

In what proportion of patients is a thunder clap headache the only symptom of subarachnoid haemorrhage?

A

1/3

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14
Q

Is the thunder clap headache more commonly distinguished by its severity or location?

A

Severity

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15
Q

What are some other possible presenting symptoms of subarachnoid haemorrhage?

A
  • Stiff neck
  • N&V
  • Photophobia
  • Diplopia
  • Stroke-like symptoms
  • Seizures
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16
Q

What may occur 3 weeks prior to subarachnoid haemorrhage?

A

Warning signs and symptoms

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17
Q

What are the warning signs and symptoms of subarachnoid haemorrhage related to?

A

Small leaks

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18
Q

What are the warning signs and symptoms of subarachnoid haemorrhage?

A
  • Headaches
  • Dizziness
  • Orbital pain
  • Diplopia
  • Visual loss
  • Sensory or motor disturbance
  • Seizures
  • Ptosis
  • Bruits
  • Dysphasia
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19
Q

What features may be found on examination in subarachnoid haemorrhage?

A
  • Depressed level of consciousness
  • Neck stiffness
  • Intraocular haemorrhages
  • Isolated pupillary dilation with loss of light reflex
  • Focal neurological signs
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20
Q

What percentage of patients will have depressed level of consciousness in subarachnoid haemorrhage?

A

66%

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21
Q

What percentage of patients will have intraocular haemorrhages in subarachnoid haemorrhage?

A

15%

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22
Q

Why do patients with subarachnoid haemorrhage have neck stiffness?

A

Due to meningeal irritation because of blood in the CSF

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23
Q

What investigations may be useful in subarachnoid haemorrhage?

A
  • CT scan without contrast
  • Angiography
  • Lumbar puncture
  • ECG
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24
Q

What is a CT scan useful for in subarachnoid haemorrhage?

A

First line investigation - correctly identifies 95-98% of cases

25
What will a CT scan show in subarachnoid haemorrhage?
Hyperdense appearance of blood in basal cisterns
26
What is angiography useful for in subarachnoid haemorrhage?
Confirming the origin of the SAH
27
Which types of angiography are useful for identifying anuerysms as cause of subarachnoid haemorrhage?
- Cerebral angiography | - CT angiography
28
What is cerebral angiography?
Injecting radiocontrast through a catheter to the brain arteries
29
What can also be done using cerebral angiography?
Coiling of the aneurysm
30
What is CT angiography?
Visualising blood vessels with radiocontrast on CT scan
31
When is a LP useful in subarachnoid haemorrhage?
If CT scan is negative but history is suggestive and it is safe to do an LP
32
What can an ECG show in subarachnoid haemorrhage?
- QT prolongation - Q waves - Dysrhythmias - ST elevation
33
What is it important not to mistake a subarachnoid haemorrhage for when looking at an ECG?
Acute MI
34
What are the differentials of subarachnoid haemorrhage?
- Other causes of headache - Stroke - Meningitis - Trauma - Cerebral venous sinus thrombosis - Cervical or carotid dissection - Hypertensive emergency
35
What is the aim of initial management in subarachnoid haemorrhage?
Prevent further bleeding and reduce the rate of complications
36
What is usually the initial step in managing subarachnoid haemorrhage?
Occlude the aneurysm to prevent bleeding
37
What is the preferred method for aneurysm occlusion in subarachnoid haemorrhage?
Endovascular obliteration by coiling
38
What do some patients require to occlude the aneurysm in subarachnoid haemorrhage?
Direct neurosurgical clipping
39
What is another immediate risk of subarachnoid haemorrhage?
Delayed cerebral ischaemia due to vasospasm
40
How is the risk of delayed cerebral ischaemia reduced in subarachnoid haemorrhage?
- Oral nimodipine (60mg/4 hours) | - Maintaining circulatory volume
41
What should every patient who has had a subarachnoid haemorrhage receive?
Specialist referral for investigation and definitive treatment
42
What supportive therapy may be needed for conscious patients with subarachnoid haemorrhage?
Analgesia and antiemetics
43
What supportive therapy may be needed for patients with reduced consciousness due to subarachnoid haemorrhage?
Intubation and ventilation
44
What should all surviving subarachnoid haemorrhage patients be advised of?
Secondary prevention
45
What are the most important secondary prevention measures in subarachnoid haemorrhage?
Treatment of hypertension and stopping smoking
46
What will a patient with residual impairment post-subarachnoid haemorrhage require?
Referral to rehabilitation services
47
What is the overall death rate of subarachnoid haemorrhage?
~50%
48
What proportion of subarachnoid haemorrhage survivors remain dependent?
1/3
49
What are the short term complications of subarachnoid haemorrhage?
- Rebleeding - Delayed cerebral ischaemia - Hydrocephalus
50
When is the risk of rebleeding highest?
In the first few days
51
What does rebleeding carry a high risk of?
Permanent disability and death
52
What happens in delayed cerebral ischaemia?
The blood vessel goes into spasm causing narrowing and dangerously low blood supply to the brain
53
What can occur as a result of delayed cerebral ischaemia?
Brain damage
54
What are the common symptoms of subarachnoid haemorrhage?
Increasing drowsiness with or without other stroke-like symptoms
55
What are the symptoms of hydrocephalus?
- Headache - Vomiting - Blurred vision - Difficulty walking
56
What are the potential long term complications of subarachnoid haemorrhage?
- Epilepsy - Cognitive dysfunction - Changes in mood
57
What cognitive dysfunction can occur as a result of subarachnoid haemorrhage?
- Memory problems - Planning problems - Concentration problems
58
What mood changes can occur after a subarachnoid haemorrhage?
- Depression - Anxiety - PTSD

A - MSRA Neuro and Stroke [12] (33 decks)

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