SAH/ sub-arachnoid haemorrhage

Question 1

SAH risk factors

Answer 1

Lifestyle:
-smoking, alcohol, drugs, diet, lack exercise
Cardiovascular diseases
-hypertension
-AF
-valvular disease
-CAD
-congestive heart failure
-congenital heart disease
Other factors
-age(55+), gender (younger men), hyperlipidaemia, diabetes, sickle cell disease, hypercoagulable diseases, chronic kidney disease
-genetic predisposition

Question 2

SAH pathophysiology

Answer 2

-undiagnosed ‘berry’ aneurysm whic ruptures
-causes bleeding between pia mater and arachnoid mater (in subarachnoid space)
-blood then build up around the brain increasing intercranial pressure
-leads to early brain injury or transient global cerebral ischaemia

Question 3

SAH signs and symptoms

Answer 3

-sudden headache- ‘thunderclap’
-stiff neck
-nausea/ vomiting
-photophobia
-blurred/ double vision
-focal neurological deficit
-confusion
-reduced LOC
-single fixed dilated pupil (bad)
-bilateral fixed dilated pupils (worse)

Question 4

SAH prodromal signs and symptoms

Answer 4

Occur 10-20 days prior to rupture
-headache
-dizziness
-orbital pain
-diplopia= double vision
-vision loss

Question 5

SAH assessment

Answer 5

-ABCD
-Disability- pupil examination (PERRLA), GCS
-history of prodromal symptoms

Question 6

SAH treatment/ management

Answer 6

-maintain ABCD
-rapid transport to nearest ED with pre alert
-actively treat any seizures