Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Week 13 - neurology > Management of subarachnoid haemorrhage > Flashcards

Management of subarachnoid haemorrhage Flashcards

1
Q

Describe aneurysm formation

A
  • Haemodynamic stress occurs, normally at the branch of a vessel
  • This causes extensive inflammatory and immunological reactions
  • If inflammation response attenuates then the aneurysm stabilise but if it continues then the aneurysm will grow and rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do the blood vessels in the brain reside?

A

In the arachnoid space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can cerebral artery aneurysms cause?

A

Subarachnoid bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can arteries that penetrate the brain tissue that then rupture cause?

A

Intracerebral bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens if a blood vessel ruptures through the Pia?

A

Parenchymal haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens if a blood vessel ruptures through the arachnoid?

A

Subdural haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is aneurysmal subarachnoid haemorrhage?

A

•Acute cerebrovascular event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the predisposing factors of an aneurysmal subarachnoid haemorrhage?

A
  • Smoking
  • Female
  • Hypertension
  • Family history
  • ADPCK, Ehlers Danlos, corctation of the aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the classical presentation of an aneurysmal subarachnoid haemorrhage?

A
  • Acute headache with a sudden onset
  • loss of consciousness, seizure, visual(ophthalmic)/speech(MCA) /limb disturbance (anterior communicating)
  • Sentinel headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the clinical signs of aneurysmal subarachnoid haemorrhage?

A
  • Photophobia
  • Meningism (neck stiffness due to the irritation of the meninges by blood)
  • Subhyaloid haemorrhage
  • Vitreous haemorrhage (red reflex lost) - terson syndrome
  • Speech/limb disturbance
  • Cardiovascular problems (e.g. pulmonary oedema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the appearance of subhyloid haemorrhage

A
  • Collection of blood, fills kind of like a cup

* Between the vitreous and the retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain the grading system of subarachnoid haemorrhage

A
  • WFNS Grades
  • GCS 15 = grade I
  • GCS 13-14 with no deficit = grade II
  • GCS with deficit = grade III
  • GCS 7-12 = Grade IV
  • GCS 3-6 = Grade V
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigations should you carry out in suspected aneurysmal subarachnoid haemorrhage?

A
  • CT to confirm diagnosis and give clues to aetiology/assess complications/prognositc
  • FBC, UEs, LFT, glucose, troponin
  • ECG
  • CTA/MRA/DSA
  • Echocardiogrpahy - tako tsubo cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If a CT scan is negative in suspected SAH, what should you do?

A

Lumbar puncture to look for oxy haemoglobin vs bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the cautions of a CTA?

A

eGFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the cautions for a MRA?

A
  • eGFR

* Gadolinium

17
Q

What are the cautions of DSA?

A
  • Diabetes

* Also there is a risk of stroke

18
Q

Explain resuscitation in patients with SAH

A
  • Bed rest
  • Fluis: 2.5-3 litres of normal saline
  • Anti-embolic stockings
  • Nimodipine
  • analgesia
  • Doppler studies
19
Q

What is the role of nimodipine in SAH?

A

Inhibits calcium dumping, preventing late ischaemia deficit

20
Q

What are the management options in SAH?

A
  • Endovascualr (coils and others)
  • Surgical clipping
  • Conservative - very few
21
Q

How can you check that you have successfully clipped an aneurysm?

A

Puncture it to ensure it isn’t filling

22
Q

Describe medicine therapy after stent assisted coiling

A
  • Use of anti platelet agents
  • Clopidogrel for 3 months
  • ASA for life (acetylsalicylic acid)
23
Q

What are the complications of a SAH?

A
  • Rehaemorrhage
  • Delayed ischaemia
  • Hydrocephalus
  • Hyponatraemia
  • Cardiovascular problems
  • LTRI, DVT/PE, UTI
24
Q

When is the risk of rehaemorrhage in SAH high?

A
  • Incidence is highest immediately following the initial bleed
  • 5-10% over 1st 72 hours
  • higher in poorer grade patients
  • Higher risk in larger aneurysms
25
Q

Describe the treatment and morbidity of rehaemorrhage

A
  • Immediate repair reduced the rebreeding risk
  • Antifibrinolytic therapy reduces rebleeding but no benefit on poor outcome die to significantly higher incidence of cerebral ischaemia
26
Q

What is the management of hydrocephalus?

A
  • LP and EVD insertion to relieve
  • If prolonged and repeated LPs are needed then shunt
  • Some will just resolve by themselves
27
Q

What causes hydrocephalus in SAH?

A

Inflammation/irrittion at the arachnoid granule level

28
Q

When is delayed ischaemia likely to happen after SAH?

A
  • Day 3-10

* Peak on day 7

29
Q

What are the signs of delayed ischaemia after SAH?

A
  • Progressive deterioration in level of consciousness associated with new deficit
  • Angiographic spasm
30
Q

What is the management of delayed ischaemia following SAH?

A
  • fluid management
  • Nimodipine
  • Inotropes
  • Angioplasty
31
Q

Describe the management of hyponatraemia following SAH

A
  • Cerebral salt wasting vs SIADH
  • Establish the volume status
  • Hypertonic saline
  • fludrocortisone
32
Q

What are the cardiopulmonary complications of SAH?

A
  • Sympathetic stimulation and catecholamine release can lead to myocardial surgery
  • Arrhythmia is 35%
  • wall motion abnormalities
  • Sudden death can occur
  • Myocardial function usually returns to normal in 1-3 days
33
Q

What are seizures post SAH often a manifestation of?

A

Re-rupture

34
Q

Explain DVT prophylaxis post SAH

A
  • SAH induces a prothrombotic state
  • DVT in SAH in 2-18%
  • Higher in poor grade
  • Safer to use sequential compression devices initially then LWMH after the aneurysm is secured
  • Withold LMWH 24 hours before and after intracranial procedures

Week 13 - neurology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions