Subarachnoid Haemorrhage Flashcards

1
Q

What is subarachnoid haemorrhage?

A

Refers to extravasation of blood in the SA space between the pia and arachnoid membrane

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2
Q

What can cause subarachnoid haemorrhage?

A

Head trauma or can be non-traumatic

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3
Q

Main cause of non-traumatic SAH?

A

Rupture of intracranial (berry) aneurysm

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4
Q

Why do berry aneurysms form?

A

Due to congenital weakness of elastic tissues in the arterial wall

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5
Q

What increases risk of berry aneurysms?

A

Increases with age

HT

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6
Q

Where do aneurysms often develop?

A

Near arterial junctions in circle of Willis

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7
Q

Factors which make intracranial haemorrhages more likely to rupture?

A
  • Smoking
  • HT
  • Location of anuerysm
  • Size of aneurysm
  • Conditions such as polycystic kidney disease
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8
Q

Other causes of non-traumatic subarachnoid haemorrhage?

A

Arteriovenous malformations

Bleeding disorders

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9
Q

Clinical features of subarachnoid haemorrhages?

A
  • Sudden onset of ‘thunderclap headache’ patients claim its the worst headache ever
  • Neck stiffness and photophobia
  • Often accompanied by vomiting/nausea
  • Third nerve palsy may occur (if posterior communicating artery)
  • Confusion, seizures and loss of consciousness can occur
  • Can get vitreous haemorrhage assoc with SAH
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10
Q

Diagnosis of SAH?

A

Usually confirmed with unenhanced CT scan where large volume of blood which appears to white is seen in suprasellar cistern, sylvian fissures and sulci

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11
Q

What to do if in doubt about SAH diagnosis?

A

Lumbar puncture

-Checking CSF for signs of blood

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12
Q

What happens when there is SA blood found in absence of history of trauma?

A

CT cerebral angiography is performed to look for berry aneurysm

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13
Q

Immediate treatment of SAH?

A

Bed rest and supportive measures

  • Control HT
  • Nimodipine (CCB for 3 weeks, reduces mortality)
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14
Q

First line treatment when angiography demonstrates aneurysm?

A

Endovascular treatment by placing platinum coils via a catheter in the aneurysm sac (To promote thrombosis)
AND
Ablation of aneurysm

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15
Q

Complications of SAH?

A
  • Vasospasm
  • Re-bleed
  • Seizures
  • Hyponatraemia
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16
Q

Why does vasospasm occur?

A

Because blood in the SA space is very irritating to vessels

-Can be prolonged arterial contraction leafing to delayed ischaemic neurological deficits

17
Q

When does vasospasm usually peak?

A

3-14 days following haemorrhage

18
Q

Presnetation of vasospasm?

A

Development of new focal neurological deficit

Present with altered state of consciousness

19
Q

Diagnosis of vasospasm?

A

Clinical diagosis and confirmed with angiogram

OR less invasively with transcranial doppler

20
Q

Treatment for vasospasm?

A

Use of nimodipine and BP control

21
Q

Management of rebleedinga dn when it is most common?

A
  • First 2 weeks + in elderly/HT patients

- Managed with surgical clipping or coiling