SAH Flashcards

1
Q

Subarachnoid hemorrhage’s (SAH) are caused by

A

A ruptured aneurysm

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2
Q

Where does the blood go in a SAH?

A

Same place as CSF flows…subarachnoid space

Blood is in between brain tissue not in the brain tissue.

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3
Q

What can happen with a SAH

A

Increased CFS pressure
Hematoma expansion
Vasospasm

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4
Q

Statistics for hematoma expansion after a SAH

A

26% will have hematoma enlargement within 1 hr.

72% have some hematoma expansion over the first 24 hrs

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5
Q

What can happen in days to weeks following a SAH?

A

Cerebral vasospasm

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6
Q

What are aneurysms?

A

Weakened bulging section of a cerebral artery

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7
Q

What is a saccular aneurysm

A

Looks like a sack or berry with a narrow neck and a widened dome

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8
Q

What are the most common types of aneurysms?

A

Saccular

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9
Q

Where do saccular aneurysms commonly form?

A

At the junction of vessels, particularly at the junction points in the circle of Willis.

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10
Q

How would you describe a fusiform aneurysm?

A

A cylindrical, longer length outpouching of the vessel.

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11
Q

Where do fusiform aneurysms form?

A

Generally located in the vertbrobasilar vascular system

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12
Q

What happened at the moment of aneurysm rupture?

A

Mechanical injury occurs from blood rushing into the subarachnoid space and sudden increase in ICP which results in a mass effect at the clinical signs of SAH.

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13
Q

Early brain injury after a ruptured brain aneurysm is caused by

A

Localized and generalized edema.
An increase of Excitatory neurotransmitter levels.
Severe reduction in cerebral blood flow in the microcirculation of the brain.
Cortical spreading depression.
Spreading ischemia.
Microvasoconstriction

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14
Q

Cerebral vasospasm is also known as

A

Delayed cerebral injury

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15
Q

When is cerebral vasospasm likely to occur?

A

Large vessel vasospasm generally begins on day 4 after the hemorrhage and May continue as long as 21 days.

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16
Q

What is the most common cause of spontaneous SAH not caused by trauma?

A

80% are due to intracranial saccular aneurysms

17
Q

What percentage of strokes and deaths are attributed to SAH?

A

3% of strokes and 5% of deaths

18
Q

What is the incidence of SAH?

A
Higher in females
Poly cystic kidney disease
Marfans syndrome
Ehlers-Danlos syndromes
Coartication of the aorta
Fibromuscular dysplasia
19
Q

Locations of SAH

A
30% ACA
25% PCA
20% MCA
10% basilar
5% vertebral
25% multiple
20
Q

Symptoms of SAH

A

Worst HA of my life
Thunder-clap headache
HA associated with focal neurologic symptoms

21
Q

If the CT is negative and there is a high suspicion of SAH, what procedure must you do and why?

A

Lumbar puncture

CT can miss small or subtle SAH

22
Q

What is the the gold standard test to diagnose Intracranial aneurysms

A

Digital subtraction angiography.

23
Q

When is rebleeding likely to occur with SAH and what percentage

A

24 hrs 4% will rebleed with high mortality

24
Q

What is the MAP goal to prevent rebleeding?

A

70-100 mm Hg

25
What is the best way to prevent re-bleeding with an aneurysm
Craniotomy and Clipping
26
What are some common complications to SAH?
Hydrocephalus Sz Cerebral vasospasm Delayed ischemic deficits
27
What percent of pts with SAH have hydrocephalus?
20%
28
What are the clinical and diagnostic signs of hydrocephalus
Decreased LOC HTN Bradycardia CT shows enlargement of ventricles
29
What is the percentage of SAH pts that experience cerebral vasospasm, when does it occur, and what percentage of pts have resulting ischemic strokes?
30% 3-5 days, maximum 5-10 days 15-20% have resulting ischemic strokes
30
Which calcium channel blocker is used to prevent cerebral vasospasm in SAH?
Nimodipine 60 mg PO every 4 hrs X 3 weeks
31
What tests are used to evaluate for cerebral vasospasm?
TCD CTA Angiography Clinical signs and symptoms
32
What is HHH for treatment of cerebral vasospasm in SAH
HTN Hypervolemia Hemodilution
33
What is the mortality associated with SAH?
3% die before reaching hospital | 1/3 died in the first month
34
What is the breakdown of mechanism of death related to SAH
1/4 are due to initial bleed 1/4 are due to vasospasm 1/4 are due to re-bleeding
35
For an u secured/unsecured aneurysm in SAH THE BP should be
>160/<160