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SCRN > SAH > Flashcards

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
Q

What is the best way to prevent re-bleeding with an aneurysm

A

Craniotomy and Clipping

26
Q

What are some common complications to SAH?

A

Hydrocephalus
Sz
Cerebral vasospasm
Delayed ischemic deficits

27
Q

What percent of pts with SAH have hydrocephalus?

A

20%

28
Q

What are the clinical and diagnostic signs of hydrocephalus

A

Decreased LOC
HTN
Bradycardia
CT shows enlargement of ventricles

29
Q

What is the percentage of SAH pts that experience cerebral vasospasm, when does it occur, and what percentage of pts have resulting ischemic strokes?

A

30%
3-5 days, maximum 5-10 days
15-20% have resulting ischemic strokes

30
Q

Which calcium channel blocker is used to prevent cerebral vasospasm in SAH?

A

Nimodipine 60 mg PO every 4 hrs X 3 weeks

31
Q

What tests are used to evaluate for cerebral vasospasm?

A

TCD
CTA
Angiography
Clinical signs and symptoms

32
Q

What is HHH for treatment of cerebral vasospasm in SAH

A

HTN
Hypervolemia
Hemodilution

33
Q

What is the mortality associated with SAH?

A

3% die before reaching hospital

1/3 died in the first month

34
Q

What is the breakdown of mechanism of death related to SAH

A

1/4 are due to initial bleed
1/4 are due to vasospasm
1/4 are due to re-bleeding

35
Q

For an u secured/unsecured aneurysm in SAH THE BP should be

A

> 160/<160

SCRN (26 decks)

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