Neuro Emergencies: SAH Flashcards
A SAH is bleeding that occurs where?
between the pia on the surface of the brain, and the arachnoid layers of the meninges
Risk Factors for SAH include
Cigarette smoking
HTN
ETOH
Genetic risk
Estrogen deficiency
Sympathomimetic drugs
Coagulopathy
Genetic risk factors for SAH include
Connective tissue d/o
Familial occurrence (In individuals w/ >/= two 1* relatives w/ known cerebral aneurysms, there is a 12% prevalence of harboring a cerebral aneurysm)
Autosomal dominant polycystic kidney disease
Marfan Syndrome
Ehlers-Danlos Syndrome
Causes of Subarachnoid Hemorrhages
Intracranial aneurysms
Trauma
Vascular malformations
Arterial dissection
Types of Intracranial Aneurysms
Saccular
Mycotic
Fusiform
Clinical Manifestations of SAH
Sudden severe headache (can have sentinel headache)
Altered LOC
Seizure
N/V
Meningisums
Cranial Nerve palsy
Focal neurological deficit
Normal exam
Coma
Systemic Complications After SAH
Early brain injury after aneurysm rupture includes
Elevated ICP w/ decreased CPP
Small and large artery constriction and thrombosis
Impaired autoregulation
Inflammation w/ cell death by necrosis and apoptosis
Cerebral edema
Blood-brain barrier disruption
Systemic Complications After SAH
Other
ECG changes
Myocardial stunning
Neurogenic pulmonary edema
SIRS
Care continuum of the patient w/ aSAH
Early Brain Injury requires?
Acute resuscitation
Emergency dx
Prevent rebleeding
treat hydrocephalus
manage elevated ICP
Manage seizures
Care continuum of the patient w/ aSAH
Delayed Brain Injury can include?
Delayed cerebral ischemia
Sodium dysregulation
systemic complications
fever and temp management
glucose management
nutritional support
Care continuum of the patient w/ aSAH
Recovery should include?
Acute rehab
HA and Seizure management
Mnitoring of aneurysms
screening for cognitive and mood d/o’s
long-term outcomes
Diagnosis Imaging
Head CT (99% sensitive and specific w/n 6h of symptom onset)
CTA
Digital Subtraction Angiography (DSA)
What is the Gold standard for evaluation of cerebrovascular anatomy and aneurysm geometry and can aid in decision making on the choice of optimal treatment modality?
Digital subtraction angiography (DSA)
Diagnosis Lab Studies?
BMP
PT/INR, PTT
CBC
troponin
Type and Screen
UDS
HCG (if appropriate)
Diagnosis bedside studies?
ECG
+/- CXR
When is a Lumbar Puncture indicated?
Sensitivity?
When clinical suspicion of aSAH is high and head CT is negative
99% sensitive when performed 12 hrs after symptom onset
SAH Grading System
Hunt and Hess Classification of SAH
Grade 1 =?
Asymptomatic, or minimal HA; slight nuchal rigidity
SAH Grading System
Hunt and Hess Classification of SAH
Grade 2 =?
Moderate to severe HA, nuchal rigidity; no neuro deficits (apart from cranial nerve palsy)