[SAH]

Answer 1

rupture of saccular (aka berry) aneurysm

Answer 2

hereditary weakness in blood vessels (esp. circle of willis)

Answer 3

ant. comm. / ant. cerebral

Post. comm. / internal carotid

Answer 4

AV malformations

Answer 5

3

Answer 6

Aneurysm due to bacterial infection of the vessel wall.

Answer 7

Polycystic kidney
Coarctation of aorta
Ehlers-Danlos (collagen, hypermobile)

Answer 8

Within seconds
worst ever headache
occipital typically

Answer 9

Seizures/collapse
coma (can last days/drowsiness for days)
vomiting

Answer 10

Neck stiffness

Answer 11

Hip and knee flexed 90
extension in the knee is painful (resistance)

Answer 12

SAH
Meningitis

Answer 13

AV malformations

Answer 14

Aneurysm due to bacterial infection of the vessel wall.

Answer 15

worst ever headache

Answer 16

days

Answer 17

SAH
Meningitis

Answer 18

occipital

Answer 19

seconds

Answer 20

Seizure –> coma

Answer 21

Polycystic kidney
Coarctation of aorta
Ehlers-Danlos (collagen, hypermobile)

Answer 22

Neck stiffness

Answer 23

after

Answer 24

vitreous/retinal bleeds - sign of SAH

Question 25

[SAH]: what is a sentinel headache

Answer 25

Prior warning headache (rare)(small leak)

Question 26

[SAH]: 1st line investigation?

Answer 26

CT (within 48hrs!)

Question 27

[SAH]: if 1st line investigation -ve what 2nd line Ix is done

Answer 27

LP

Question 28

[SAH]: How long after SAH do you have to wait before perfoming an LP

Answer 28

>12hrs

Question 29

[SAH]: In LP what would be found

Answer 29

xanthochromia (yellow - bilirubin) *only red in the acute early phase OR a bloody tap*

Question 30

[SAH]: Mx: how soon should patients be referred to neurosurgeons

Answer 30

immediately

Question 31

[SAH]: Mx: what systolic BP should you aim for?

Answer 31

>160mmHg

Question 32

[SAH]: Mx: Why do you aim to keep the BP high?

Answer 32

maintain cerebral perfusion

Question 33

[SAH]: Mx: what drug is given is reduce vasospasm?

Answer 33

Nimodipine (60mg/4hrs

Question 34

[SAH]: Mx: what is nimodipine?

Answer 34

Ca2+ antagonist - reduced vasospasm

Question 35

[SAH]: Mx: what is the 1st line surgical treatment

Answer 35

Endovascular coiling

Question 36

[SAH]: Mx: what investigation MUST you do in an already proven SAH case before surgically intervening

Answer 36

catheter/CT angiography

Question 37

[SAH]: Mx: why must you do further imaging in an already proven case of SAH

Answer 37

to identify single or multiple aneurysms

Question 38

[SAH]: what is the commonest complication causing death post treatment

Answer 38

rebleeding

Question 39

[SAH]: what is the complication associated with vasospasm

Answer 39

Cerebral ischaemia causing permanent CNS deficits

Question 40

[SAH]: what is the complication associated with vasospasm

Answer 40

Cerebral ischaemia causing permanent CNS deficits

Question 41

[SAH]: what is the commonest cause of mortality

Answer 41

rebleeding

Question 42

[SAH]: what is them commonest cause of morbidity

Answer 42

cerebral ischaemia

Question 43

[SAH]: What sign is

Answer 43

Neck stiffness

Question 44

[SAH]: what is them commonest cause of morbidity

Answer 44

cerebral ischaemia

Question 45

[SAH]: is SAH associated with neck stiffness

Answer 45

Yes

Question 46

[SAH]: is SAH associated with neck stiffness

Answer 46

Yes

Question 47

[SAH]: Hydrocephalus is a recognised complication, what causes this

Answer 47

blockage of arachnoid granulations

Question 48

[SAH]: how is hydrocephalus treated

Answer 48

ventricular/lumbar drain