Subarachnoid Haemorrhage

Question 1

define subarachnoid haemorrhage?

Answer 1

Blood in subarachnoid.

Question 2

usual cause?

Answer 2

trauma to head

Question 3

RF for SAH?

Answer 3

o	Age 
o	HTN 
o	Smoking 
o	FHx 
o	Polycystic kidney disease 
o	Alcohol excess

Question 4

causes of SAH are split into what two categories?

Answer 4

Traumatic and spontaneous

Question 5

most common cause for spontaneous SAH?

Answer 5

Burst berry aneurysm

Question 6

common location for a burst berry aneurysm?

Answer 6

o Junction between anterior communicating artery and

anterior cerebral artery

Question 7

other causes of a spontaneous SAH?

-4

Answer 7

AV malformation
Mycotic aneurysm
Vertebra artery dissection
Tumour

Question 8

Aneurysm at PcommA presses on what nerve?

Answer 8

CN 3

Question 9

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

Answer 9

down and out, ptosis, mydriasis

Question 10

in which spaces will blood collect from a subarachnoid haemorrhage?

Answer 10

Basal cisterns and ventricles

Question 11

blood collecting in ventricles will cause what complication?

Answer 11

Hydrocephalus

Question 12

how many pts with SAH will get hydrocephalus?

-% wise

Answer 12

20-30%

Question 13

drug given for hydrocephalus?

conclusive treatment for hydrocephalus?

Answer 13

mannitol

VP shunt

Question 14

blood leaking in and around brain tissue will cause what?

explain pathophys behind the vasospasm in SAH?

Answer 14

vasospasm

Question 15

explain pathophys behind the vasospasm in SAH?

Answer 15

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

Question 16

initial prognosis for subarachnoid haemorrhage?

Answer 16

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

Question 17

rebleed risk at 1 month?

-%

Answer 17

22%

Question 18

difference between ischaemia and infarct?

Answer 18

ischaemia - less blood, reversible

infarct - cell death, irreversible

Question 19

what electrolyte complication can happen from subarachnoid haemorrhage?

Answer 19

cerebellar salt wasting syndrome

Question 20

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

Answer 20

low Na+

Question 21

cerebellar salt wasting syndrome effect on blood volume?

why

Answer 21

low blood volume

because low Na+

Question 22

pathophysiology behind cerebellar salt wasting syndrome

Answer 22

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

Question 23

cerebellar salt wasting syndrome causes ↓Na+.

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

Answer 23

seizures & cerebral oedema

Question 24

main symptom of SAH?

Answer 24

Thunderclap headache

very sudden + very painful

Question 25

signs on examinations? | -1 main one

Answer 25

↓GCS

Question 26

1st line Ix for all pts? | -2

Answer 26

Urgent CT head & ECG

Question 27

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

Answer 27

LP

Question 28

positive result on LP is pt has subarachnoid haemorrhage?

Answer 28

xanthochromia

Question 29

pt with subarachnoid haemorrhage has LP, | colour of LP?

Answer 29

yellow

Question 30

why do you get xanthochromia in LP?

Answer 30

haemoglobin breakdown to bilirubin

Question 31

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

Answer 31

CT angiogram with injected dye

Question 32

acute drug given in SAH?

Answer 32

Nimodipine

Question 33

moa of nimodipine? what complication does this help in SAH?

Answer 33

blocks L-type Ca2+ channels in blood vessels vasospasm

Question 34

conclusive treatment for SAH?

Answer 34

Endovascular coil put in aneurysm

Question 35

Mx for cerebellar salt wasting syndrome? | -2 things

Answer 35

salty saline, check U+Es daily

Question 36

definitive treatment for hydrocephalus?

Answer 36

VP shunt

Question 37

if coil CI what surgery do you for an aneurysm?

Answer 37

Surgically clip the aneurysm via craniotomy