Subarachnoid Haemorrhage Flashcards

1
Q

define subarachnoid haemorrhage?

A

Blood in subarachnoid.

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2
Q

usual cause?

A

trauma to head

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3
Q

RF for SAH?

A
o	Age 
o	HTN 
o	Smoking 
o	FHx 
o	Polycystic kidney disease 
o	Alcohol excess
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4
Q

causes of SAH are split into what two categories?

A

Traumatic and spontaneous

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5
Q

most common cause for spontaneous SAH?

A

Burst berry aneurysm

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6
Q

common location for a burst berry aneurysm?

A

o Junction between anterior communicating artery and

anterior cerebral artery

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7
Q

other causes of a spontaneous SAH?

-4

A

AV malformation
Mycotic aneurysm
Vertebra artery dissection
Tumour

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8
Q

Aneurysm at PcommA presses on what nerve?

A

CN 3

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9
Q

3rd nerve palsy from PCA aneurysm, how will eyes look?

A

down and out, ptosis, mydriasis

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10
Q

in which spaces will blood collect from a subarachnoid haemorrhage?

A

Basal cisterns and ventricles

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11
Q

blood collecting in ventricles will cause what complication?

A

Hydrocephalus

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12
Q

how many pts with SAH will get hydrocephalus?

-% wise

A

20-30%

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13
Q

drug given for hydrocephalus?

conclusive treatment for hydrocephalus?

A

mannitol

VP shunt

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14
Q

blood leaking in and around brain tissue will cause what?

explain pathophys behind the vasospasm in SAH?

A

vasospasm

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15
Q

explain pathophys behind the vasospasm in SAH?

A

blood breaks down > irritates nearby BVs > stops NO being made > vasospasm

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16
Q

initial prognosis for subarachnoid haemorrhage?

A

1/3 die
1/3 neuro deficit
1/3 completely fine

17
Q

rebleed risk at 1 month?

-%

A

22%

18
Q

difference between ischaemia and infarct?

A

ischaemia - less blood, reversible

infarct - cell death, irreversible

19
Q

what electrolyte complication can happen from subarachnoid haemorrhage?

A

cerebellar salt wasting syndrome

20
Q

in cerebellar salt wasting syndrome what electrolyte level changes and how does it change?

A

low Na+

21
Q

cerebellar salt wasting syndrome effect on blood volume?

why

A

low blood volume

because low Na+

22
Q

pathophysiology behind cerebellar salt wasting syndrome

A

SAH > peptides released > triggers Na+ excretion from kidneys, water naturally flows = hyponatraemic and hypovolaemic.

23
Q

cerebellar salt wasting syndrome causes ↓Na+.

what complications can ↓Na+ cause/exacerbate in the context of SAH?
-2

A

seizures & cerebral oedema

24
Q

main symptom of SAH?

A

Thunderclap headache

very sudden + very painful

25
Q

signs on examinations?

-1 main one

A

↓GCS

26
Q

1st line Ix for all pts?

-2

A

Urgent CT head & ECG

27
Q

if CT inconclusive but you still suspect SAH, what is next Ix?

A

LP

28
Q

positive result on LP is pt has subarachnoid haemorrhage?

A

xanthochromia

29
Q

pt with subarachnoid haemorrhage has LP,

colour of LP?

A

yellow

30
Q

why do you get xanthochromia in LP?

A

haemoglobin breakdown to bilirubin

31
Q

if LP contraindicated, what is next Ix to confirm subarachnoid haemorrhage?

A

CT angiogram with injected dye

32
Q

acute drug given in SAH?

A

Nimodipine

33
Q

moa of nimodipine?

what complication does this help in SAH?

A

blocks L-type Ca2+ channels in blood vessels

vasospasm

34
Q

conclusive treatment for SAH?

A

Endovascular coil put in aneurysm

35
Q

Mx for cerebellar salt wasting syndrome?

-2 things

A

salty saline, check U+Es daily

36
Q

definitive treatment for hydrocephalus?

A

VP shunt

37
Q

if coil CI what surgery do you for an aneurysm?

A

Surgically clip the aneurysm via craniotomy