Sub arachnoid haemorrhage Flashcards
What is a subarachnoid haemorrhage
bleeding between Arachnoid and Pia Mata
How would you describe the headache presented in SAH
Thunderclap or “blow to the back of head”
What are the risk factors for SAH
HTN Aneurysm Smoking Alcohol Polycistic kidney disease Aortic coarctation Ehlers and Marfans
What are the main risk factors for a berry aneurysm
Polycystic Kidney Disease
Aortic coarctation
Ehlers and Marfans
What can cause SAH
Berry aneurysm rupture (Circle of willis)
Arterovenous Malformation
-Tangled vessels
Idiopathic
Trauma to Anterior comms and ACA junction
What 5 ways can SAH occur
-Ischemia -Raised ICP -Lesion -Blood irritating meninges -Vasospasm
Why can a lesion cause SAH
Pressure is applied on the brain
How can Vasospasm cause SAH
Bleeding irritate blood vessels causing Ischaemia
How can irritated meninges cause SAH
Blood irritates meninges
Meninges inflame and ause CSF obstrcution
Hydrocephalus occurs
What is Hydrocephalus
Fluid build up in the deep ventricles of the brain
What are the main symptoms of SAH
Thunderclap headache
Sentinel headache prior to Thunderclap
N+V
LOW Consciousness
CN3/6 Palsy
What are the signs of SAH
Stiff neck Kerrig's sign Brudzinski's sign Retinal bleeds w/ pappiloedema Focal neurological signs HTN
What are focal neurological signs
paralysis
nerve palsy
tremors
lost muscle control
What is the Kerrig’s sign
Knee extension causes pain
What is the Brudzinki’s sign
Neck flexion = Knee flexion
What is the urgent investigation in SAH
Brain CT <24 HOURS
What would a brain CT show
Star shaped with no ventricles
SAH = STAR
What investigation would you do after 12 hours of SAH or if CT is negative
Lumbar puncture
-Only with normal ICP (no coning)
What would a positive lumbar puncture show for subarachnoid haemorrhage
Xanthochromia (Red blood cell breakdown product)
CSF =Yellow (rbc waste)
What other investigations could you do in SAH
MR/CT angiography
-imaging to find source of bleed)
What are the surgical interventions in SAH
Endovascular coiling Surgical clipping (If aneurysm present)
How would you manage SAH
Urgent brain CT and referral
Lumbar puncture to check CSF
IV Fluid (for Cerebral perfusion)
How would you manage Hydrocephalus in SAH
Ventricular drainage
How would you manage SAH caused by Vasospasm
Nimodepine (Calcium antagonist)
- 3 weeks
- Decrease ischaemia = decrease vasospasm
What scoring scale is used in coma assessment
Glasgow coma scale
Describe the Glasgow Coma Scale
0-3 No response
3-8 Coma
8-15 Normal
What are the main 2 differentials for Subarachnoid haemorrhage
Meningitis - Infection no thunderclap
MIgraine - No Meningism, No thunderclap
