SAH

Question 1

Define (is it arterial or venous)

Answer 1

Arterial haemorrhage into subarachnoid space

Question 2

Risk factors

Answer 2

HTN
Smoking
Excess alcohol
Berry aneurysms

Question 3

What are berry aneurysms associated with?

Answer 3

Autosomal dominant polycystic kidney disease
Marfan’s
EDS

Question 4

Epidemiology

Answer 4

Peak incidence: 40s

Incidence: 10/100000

Question 5

Symptoms

Answer 5

Sudden onset worst headache ever 'thunderclap/hit in the back of head with a baseball bat'
Nausea/vomiting 
Neck stiffness 
Reduced level of consciousness
Photophobia

Question 6

Where does the pain arise and spread?

Answer 6

Back of head, spreads to front

Question 7

Signs

Answer 7

Neck stiffnes
Pyrexia 
Kernig's sign
GCS deterioration 
Signs of raised ICP 
Focal neurological signs e.g. CN palsies

Question 8

Describe a positive Kernig’s sign

Answer 8

Patient lays flat and you flex their hip and extend their knee

If they experience generalised spinal pain, involuntary flexion of opposite hip or resist the pain, it is positive

Question 9

Give signs of raised intracranial pressure

Answer 9

HTN
Bradycardia
Papillooedema
3rd or 4th nerve palsies

Question 10

Investigations

Answer 10

CT scan
Angiogrpahy
Bloods (FBC, U&Es, ESR/CRP, clotting)
Lumbar puncture if ICP is not high

Question 11

What would a lumbar puncture show?

Answer 11

Increased opening pressure
Increased red cells?
Xanthochromia