Sub-arachnoid haemorrhage Flashcards

1
Q

What is the definition of a sub arachnoid haemorrhage?

A

Spontaneous arterial bleed into the subarachnoid space

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2
Q

How common are sub arachnoid haemorrhage?

A

Annual incidence of 6 per 100,000

Mean age of presentation is 50 years old

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3
Q

What is the pathophysiology of a sub arachnoid haemorrhage?

A
  • Berry aneurysms are most common at the bifurcations/branches of the arteries/Circle of Willis
  • Most asymptomatic until they rupture
  • Some become symptomatic due to mass effect
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4
Q

What are the risk factors/aetiology of sub arachnoid haemorrhage?

A
  • Rupture of berry/saccular aneurysms
  • Congenital arteriovenous malformations
  • Hypertension
  • Atherosclerosis
  • Cocaine
  • ↑ alcohol
  • Trauma
  • Genetics
  • Family history
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5
Q

What are the signs/symptoms of a sub arachnoid haemorrhage?

A
  • Painful 3rd nerve palsy – due to mass effect
  • Sudden onset of severe ‘thunderclap’ occipital headache – reaches maximum intensity within minutes
  • Nausea/vomiting
  • Seizures
  • Sometimes loss of consciousness/dizziness
  • Neck stiffness – sign of meningeal irritation
  • +ve Kernig’s sign – sign of meningeal irritation
  • Focal neurological signs
  • Papilloedema
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6
Q

What diseases present similarly to sub arachnoid haemorrhage?

A
  • Tension headache
  • Migraine
  • Stroke
  • Meningitis
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7
Q

What investigations are carried out for a suspected sub arachnoid haemorrhage?

A
  • CT – as soon as possible
  • LP – when strong clinical suspicion of sub arachnoid haemorrhage but CT is normal
  • ↑ bilirubin/oxyhaemoglobin which leads to a red/brown colouration
  • Must be performed at least 12 hours after symptoms
  • MR angiogram
  • ECG
  • Ophthalmoscopy = intraocular haemorrhages
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8
Q

What are the surgical treatments for a sub arachnoid haemorrhage?

A

• Obliteration of the aneurysm by surgical clipping/insertion of a fine wire coil

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9
Q

What are the pharmacological treatments for a sub arachnoid haemorrhage?

A
  • Nimodipine (Ca channel blocker)
  • Saline fluids – counteract hyponatraemia
  • Antihypertensive - prevention
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10
Q

What are the non pharmacological treatments for a sub arachnoid haemorrhage?

A
  • Bed rest
  • Supportive measures
  • Smoking cessation - prevention
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