Subarachnoid Haemorrhage

Question 1

What is a subarachnoid haemorrhage? What are the risk factors for having a subarachnoid haemorrhage?

Answer 1

Ruptured cerebral artery/ies leads to bleeding into subarachnoid space between the pia mater and arachnoid mater where CSF located

RF:

• hypertension
• smoking
• excessive alcohol consumption
• cocaine use
• FH
• cocaine use
• sickle cell anaemia
• CT disorders i.e. Marfan and Ehlers-Danlos

Question 2

What is the red flag sign which implies a subarachnoid haemorrhage has occured?

Answer 2

Thunderclap headache
-sudden onset occipital headache= feels like being hit very hard on back of head

In association with:

• neck stiffness
• photophobia
• vision changes
• speech changes
• weakness
• seizures

Question 3

What is the 1st line investigation? Why? What would you expect to see if subarachnoid haemorrhage had occured? Why might CT scan be negative despite SAH having occured?

Answer 3

CT head= need to determine whether symptoms are due to ischaemic stroke or haemorrhagic stroke
I.e. cannot give thrombolysis until CT done

Would see hyperattenuation in subarachnoid space (appear as white) due to the blood

Delay in scan can lead to the blood being reabsorbed into tissue and diagnosis missed

Question 4

What is the next line of investigation if CT scan is negative in suspected subarachnoid haemorrhage?

Answer 4

Lumbar puncture

• raised red cell count
• appears yellow (xanthochromia)- raised bilirubin

Question 5

What are the 2 different surgical interventions which can be used in subarachnoid haemorrhage?

Answer 5

Coiling= endovascular
-platinum coil guided to aneurysm site via catheter to seal artery

Clipping= cranial
-clip aneurysm to seal it

Question 6

Why might someone with subarachnoid be given nimodipine?

Answer 6

Calcium channel blocker to prevent vasospasm which can cause brain ischaemia
NOTE: vasospasm induced as reaction to cerebral oedema

Question 7

What condition can occur as a complication of subarachnoid haemorrhage? How is it treated?

Answer 7

Hydrocephalus

Can insert shunt into ventricles to ensure drainage of CSF and relieve pressure

Question 8

What are differential diagnoses for a thunderclap headache?

Answer 8

Encephalitis 
Meningitis 
Migraine
Central venous thrombosis 
Pituitary apoplexy= mini stroke in pituitary gland

Question 9

How can SAH be managed medically?

Answer 9

Nimodipine= CCB to prevent vasospasm
Anti-epileptics if person experiencing seizures
Analgesia
Maintain BP <180