Subarachnoid Flashcards
Risk factors for SAH
Htn dia 105, smoking, fungal, oct, liver, trauma, arm, cocaine, amph
Percent of stroke that are SAH
10
Biggest risk factor for SAH
Fibro muscular dysplasia 25% of aneurysm
Most common place for Subarachnoid aneurysm
1/3rd are in anterior
Internal carotid bifurcation with post
Ic with mca
How many with aneurysm have more than 1
25 percent
Percent of SAH assoc with poly coatis kidney disease
3% overrated
Mean age of SAH
50
Context of SAH
60 % During activity.
Don’t forget about asking about what w SAH in history
Prior episodes
Types of activity associated with SAH
Colitis dedication emotional strain I
What does mydriasis mean
Cranial nerve 3 deficit, uncal hernia midbrain problem
Cn 3 plus Hemiparesis wo gate abnormality
Weber syndrome
Posterior communicating
Lab findings with SAH
Hyponatriemia
Qt
Cz of SAH Na deficit
Salt wasting, cerebral wasting, siadh
Cz of nuchal rigidity patho
Blood degradation products irritate the pia arachnoid which cause stiffness
Peak of vasospasm in days
4 to 14 days
How do you detect vasospasm
Trancranial Doppler can be used to detect a change in flow velocity
How is a acute communicating hydrocephalus caused from patho
Subarachnoid granulation in the venous sinuses obstruct
Percent of nontraumatic aneurysm that are caused by berry
80%
Most are associated w trauma
SAH associated with what vital.
Diastolic 110
Head ct sensitivity of SAH
85 to 90, miss 10 to 15
When is ct most sensitive for dr erecting SAH
At 24 hr
When is lp most sensiive for SAH
12 hr
What percent of lp miss SAH
10 to 15
How do you scene for aneurysm of SAH
Ct MRI angio
Percent of SAH that die in the first 30 days
60 percent
Hess and hunt category
- Nuchal and mild ha
- Nuchal and sever ha
- Nuchal and confusion
- Nuchal and Hemiparesis
- Nuchal and comatosed
What does miningius mean
Inflammation without infection
What is the miningismus triad
Headache
Neck
Photophobia
Drug if choose to prevent vasospasm
Nimotop
Sensitivity and specificity of kernig and brudinski ski
5% sens but 95%
What is the sensitivity of nuchal rigidity
30 sens 80 sens
If you see a SAH rupture and are thinking neurosurgey
Conventional angiography
What consult will you place for an SAH
Coiling specialist. Neurointerventionalist
Grade and surgery for SAH
Low grade is coil
High grade clip
When do you clip an aneurysm
Before two days or after 2 weeks
Complication of SAH
Siadh
Hydrocephalus
Mainstay med management of SAH
Triple H therapy Htn Hyper volume Hemodilution Nimodipine
How do you evaluate hyper acute Hemiparesis
Diffuse weight MRI
SAH w 3 rd cranial nerve problem suggests which artery
Posterior communicating
SAH e cn 6 suggest what type of artery
Posterior fossa or increase pressure.
What do you call a bleed from am unruptures aneurysm
Sentinel bleed
What percent of stroke is SAH
5%
What present of primary stroke is anueysm
80 an
What percentage of aneurysm re bleeding?
Mortality if untreated ?
50%
50% mortality of untreated
Where are all aneurysms located?
If not there, what?
Circle of Willis
My Cotic
Avm induced aneurysm
Work up for SAH
Ct to locate bleed, mra
Catheter angio
Most common places for aneurysm
Communicators (ant and pos) 35%
What imaging is good for encephalopathy
MRI dt white matter changes
HSV perfer what area of the brain
Insular and temporal lobe
