Subarachnoid haemorrhage

Question 1

What is it?

Answer 1

Bleeding into the subarachnoid space

Question 2

What are the risk factors?

Answer 2

HTN
Smoking
Cocaine use
Excessive alchol consumption
FH

More common in people aged 45-70, women and afro-caribbean

Question 3

What are the symptoms?

Answer 3

Thunderclap headache
Neck stiffness and photophobia
LoC
Seizures
Vision changes
Neurological symptoms

Question 4

What are the signs?

Answer 4

Neck stiffness
-kernig sign positive after 6 hours

On fundoscopy

• papilloedema
• can have retinal haemorrhages

Question 5

What are the causes?

Answer 5

Berry aneurysms
AV malformations
Arterial dissection

Question 6

What investigations are needed?

Answer 6

Bloods

• FBC
• U&Es
• LFTs
• Clotting

CT head
- look for bleeding and AV malformations

LP if CT head normal
-xanthochromic (bilirubin present) if SAH

AS SOON AS SAH CONFIRMED THEN REFER TO NEUROSURGERY

CT/MRI angiography to look at vasculature in patients fit for surgery

Question 7

What is the management?

Answer 7

If aneurysm cause then surgery needed
-before surgery bed rest, no straining and control BP

Nimodipine to prevent vasospasm and fluids to prevent vasospasm

Analgesia and anti-emetics as required

Question 8

What are complications?

Answer 8

Death
Rebleed
-aneurysm within few days
-AV within few years

Hydrocephalus

Cerebral vasospasm causing ischaemic damage