Neuro conditions: Intracranial bleed

Question 1

Types of SAH. Which is more common

Answer 1

Traumatic (more common)

Aneurysm

Question 2

When should a CT head be done for SAH

Answer 2

Within 6h (100% sensitivity and specificity in that timeframe)

Question 3

When should a lumbar puncture be done for SAH

Answer 3

Around 12h

CT head is most reliable within 6h, and blood takes 6h to breakdown

Question 4

What is the main feature of an LP in SAH

Answer 4

Bilirubin

Question 5

How to differentiate traumatic vs aneurysm SAH on CT

Answer 5

Traumatic:
Blood located in cerebral sulci

Aneurysm:
Blood located in
-circle of Willis OR
-basal cisterns OR
-sylvian fissure (where the MCA runs through)
OR

Hydrocephalus (visible lateral horns)

Question 6

Management of traumatic SAH

Answer 6

Supportive:

• painkillers
• antiemetics
• raise head
• fluids

Question 7

Management of aneurysm SAH

Answer 7

• Supportive
• Nimodipine (CCB) to prevent vasospasm
• Surgical coil/clip within 48h