Sub-Arachnoid Haemorrhage

Question 1

What is the first line investigation for SAH? And when does this have the best diagnostic accuracy?

Answer 1

Non-contrast CT head
Within 6 hours of symptoms onset

Question 2

If a CT scan done within 6 hours of symptom onset does not show evidence of SAH, should you do a lumbar puncture?

Answer 2

Not routinely
Consider other diagnosis

Question 3

If a CT scan done after 6 hours of symptom onset does not show evidence of SAH, should you do a lumbar puncture?

Answer 3

Yes

Question 4

How long after symptom onset should you wait to do a lumbar puncture?

Answer 4

12 hours

Question 5

If a CT scan does show evidence of SAH, should you do a lumbar puncture?

Answer 5

No as don’t need it for evidence

Question 6

What is the name of the lumbar puncture finding in SAH?

Answer 6

Xanthochromia (bilirubin in CSF)

Question 7

If CT scan is positive, what further scan should be done?

Answer 7

CT angiography

Question 8

If CT angiography does not show cause of SAH, what should be done next?

Answer 8

Digital subtraction angiography
OR
Magnetic resonance angiography

Question 9

What medication should be prescribed to people with (aneurysmal) SAH)?

Answer 9

Nimodipine

Question 10

Which is the preferred definitive management for SAH?

Answer 10

Endovascular coiling

Do neurosurgical clipping if unsuitable

Question 11

What is the management of hydrocephalus caused by SAH?

Answer 11

Drainage or diversion of cerebrospinal fluid

Question 12

What is the management of delayed cerebral ischaemic in SAH?

Answer 12

Ensure euvolaemia
Consider vasopressor if symptoms persist