SAH

Question 1

List 8 RFs for SAH.

Answer 1

1. Family hx
2. Polycystic Kidney Disease
3. Connective tissue disorders - Ehlers-Danlos, Marfans
4. ETOH abuse
5. Female sex
6. Known berry aneurysm
7. HTN
8. Smoking
9. Sympathomimetic drugs

Question 2

List 4 clinical features that suggest SAH.

Answer 2

1. Thunderclap onset
2. N+V (75%)
3. Meningism (25%)
4. Seizures (17%)
5. ALOC

Question 3

Outline two clinical and one radiological grading systems for SAH. What does each predict?

Answer 3

Clinical:

Hunt and Hess:

0 - Unruptured aneurysm

1 - Asymptomatic or mild headache + slight nuchal rigidity

2 - Mod/severe headache, nuchal rigidity, only CN palsy as neuro deficit

3 - Drowsiness, confusion, +/- mild focal deficit

4 - Stupor, mod/severe hemiparesis

5 - Deep coma, decerebrate posturing

WFNS:

I – GCS 15, no motor deficit

II – GCS 13-14, no motor deficit

III – GCS 13-14, motor deficit

IV – GCS 7-12 +/- motor deficit

V – GCS 3-6, motor deficit present or absent

Radiologic

Fisher (or modified Fisher)

Predicts risk of vasospasm

I – no blood

II – diffuse deposition of SAH without clots or layers of blood >1mm

III – localized clots and/or vertical layers of blood 1mm or > thickness

IV – diffuse or no subarachnoid blood but intracerebral or intraventricular clots

Question 4

What is the sensitivity of CT to detect SAH at:

• 24h?
• 1wk?

Answer 4

• 90%
• 50%

Question 5

How long does xanthochromia take to form in the CSF post SAH?

Answer 5

12h

Question 6

List the possible ECG findings in a patient with SAH.

Answer 6

• ST changes (inc’g STE)
• U-waves
• Long QT

Question 7

List four radiological factors on head CT that indicate severity.

Answer 7

• Presence of blood
• Presence of clots or layers of blood
• Thickness of blood >1mm
• Intraventricular or intracerebral extension