Subarachnoid Haemorrhage

Question 1

ESSENCE

Answer 1

Bleeding in the subarachnoid space, where CSF is located between the pia mater and arachnoid membrane

Question 2

AETIOLOGY

Most common cause

Answer 2

Ruptured cerebral aneurysm

Question 3

CLINICAL FEATURES

Presentation

Answer 3

• Thunderclap headache
  
  • Sudden onset occipital headache occuring during strenous activity such as weight lifting or sex
• Neck stiffness
• Photophobia
• Vision changes
• Neurological symptoms such as speech changes, weakness, seizures and loss of consciousness

Question 4

AETIOLOGY

Risk factors

Answer 4

• Hypertension
• Smoking
• Excessive alcohol consumption
• Cocaine use
• FH

Question 5

AETIOLOGY

Diseases associated with

Answer 5

• Sickle cell anaemia
• Connective tissue disorders (such as Marfan syndrome or Ehlers-Danlos)
• Neurofibromatosis
• Autosomal dominant polycystic kidney disease

Question 6

EPIDEMIOLOGY

Race, sex and age

Answer 6

• Black
• Female
• Age 45-70

Question 7

INVESTIGATIONS

First choice

Answer 7

• CT head - first line
• Lumbar puncture - if CT head is negative
• Angiography (CT or MRI) - once confirmed diagnosis to locate source

Question 8

CT head shows

Answer 8

Hyperattenuation in subarachnoid space

Question 9

Lumbar puncture shows

Answer 9

• Red cell count raised
• Xanthochromia (yellow colour of CSF caused by bilirubin)

Question 10

MANAGEMENT

General principles

Answer 10

• Managed by specialist neurosurgical unit
• If reduced consciousness may need intubation and ventilation
• Surgical intervention to treat aneurysms
• Nimodipine (CCB) to prevent vasospasm
• Lumbar puncture or insertion of shunt to treat hydrocephalus
• Antiepileptic medications to treat seizures

Question 11

PROGNOSIS

Mortality and morbidity

Answer 11

Very high mortality and morbidity, so important to diagnose early and treat

Question 12

COMPLICATIONS

Answer 12

• Neuropsychiatric problems
• Chronic hydrocephalus