Neurology - Subarachnoid haemorrhage

Question 1

Who is it important to refer subarachnoid haemorrhage patients to?

Answer 1

It needs to be discussed with the neurosurgical unit with a view to surgical intervention.

Question 2

Presentation of subarachnoid haemorrhage

Answer 2

Thunderclap headache

Neck stiffness
Photophobia
Vision changes
Nausea and vomiting
Neurological symptoms such as speech changes, weakness, seizures and loss of consciousness

Question 3

Risk factors for subarachnoid haemorrhage

Answer 3

Hypertension
Smoking
Excessive alcohol consumption
Cocaine use
Family history

Question 4

Subarachnoid haemorrhage is associated with

Answer 4

Hypertension

Cocaine use

Sickle cell anaemia

Connective tissue disorders e.g. Marfan, EDS

Neurofibromatosis

Autosomal dominant PCKD

Question 5

Investigations in suspected subarachnoid haemorrhage

Answer 5

CT head first line (immediate)

LP can be done if uncertain diagnosis e.g. CT head negative (usually after 24h):

• Raised RCC
• Xanthochromia (due to raised bilirubin)

Angiography (CT or MRI) can be used once SAH confirmed, to locate source of bleeding

Question 6

Management of SAH

Answer 6

Management by a surgical neurosurgical unit

MDT

Surgical intervention may be used to treat aneurysms e.g. endovascular coiling or clipping

Nifedipine - presents vasospasm (vasospasm is a common complication that can result in brain ischaemia following SAH)

LP or insertion of a shunt to treat hydrocephalus

Antiepileptics to treat any seizures