Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

finals: medicine > Subarachnoid haemorrhage > Flashcards

Subarachnoid haemorrhage Flashcards

1
Q

Define the term Subarachnoid haemorrhage

A

Defined as a bleed in the subarachnoid space, space between the arachnoid and pia mater, two meningeal layers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Subarachnoid haemorrhage is a bleed in which part of the brain

A

In the subarachnoid space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The subarachnoid space is a space between which two layers of the meninges

A

arachnoid and pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CSF is found between which two meninges

A

Arachnoid and pia mater - within the subarachnoid space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name the two classifications of a subarachnoid hemorrhage

A

Traumatic subarachnoid haemorrhage

Spontaneous subarachnoid haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define the term Traumatic subarachnoid haemorrhage

A

Refers to a subarachnoid haemorrhage in the presence of trauma e.g., fall, assault, road traffic collision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define the term Spontaneous subarachnoid haemorrhage

A

Refers to a subarachnoid haemorrhage in the absence of trauma e.g., ruptured of a cerebral aneurysm, arteriovenous malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the two key risk factors for subarachnoid hemorrhage

A

Smoking

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name the 4 modifiable risk factors for subarachnoid hemorrhage

A
  • Hypertension
  • Smoking
  • Alcohol abuse
  • Substance misuse e.g. cocaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name the non-modifiable risk factors for subarachnoid hemorrhage

A
  • Sex: higher incidence in female
  • Race: higher incidence in Japanese/Finnish populations
  • Family history of aneurysms
  • Genetic predisposition: seen in conditions such as sickle cell anaemia, Marfan syndrome, Ehlers-Danlos syndrome, autosomal dominant polycystic kidney disease
  • Age: 45-70
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

subarachnoid hemorrhage has a higher incidence in:

a) males
b) females

A

b) females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What genetic conditions are a risk factor for subarachnoid hemorrhage

A

Sickle cell anaemia

Marfan syndrome

Ehlers-Danlos syndrome

Autosomal dominant polycystic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the key (red flag) symptom of a subarachnoid hemorrhage

A
  • Sudden-onset or ‘thunderclap’ headache
    • Severe headache that reaches maximum intensity within seconds
    • Often described as the “worst headache of my life”
    • Described as a :blow to the back of the head”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 3 symptoms that make up the Meningism picture

A
  • Headache
  • Photophobia (difficult tolerating light)
  • Neck stiffness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What brings about a Meningism picture

A

Occurs when there is meningeal irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name the signs of subarachnoid hemorrhage

A
  • Neck stiffness
  • Cranial nerve palsy (e.g. third nerve palsy)
  • Reduced consciousness (coma)
  • Diplopia (double vision)
  • Ptosis (dropping of upper eyelid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name the two classic signs of meningism

A

Kernig’s sign

Brudzinski’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What two conditions cause a meningism picture

A

Bacterial meningitis

Subarachnoid haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the Kernig’s sign

A

It is one of the classic signs of meningism

It refers to the inability to fully extend at the knee when the hip is flexed at 90º due to pain due to the stretching of the meninges

20
Q

What is the Brudzinski’s sign

A

It is one of the classic signs of meningism

It occurs when on spontaneous flexion of the knees and hips on active flexion of the neck

21
Q

What is the gold standard investigation for subarachnoid haemorrhage

A

CT head

22
Q

If the CT head is negative, what other investigation must you conduct for subarachnoid haemorrhage

A

Lumbar puncture

23
Q

Describe what you would see on a CT head if a patient had a subarachnoid haemorrhage

A
  • Hyperdense material (bright on CT) is seen filling the subarachnoid space.
  • Most commonly the hyperdense material is apparent around the Circle of Willis, on account of the majority of berry aneurysms occurring in this region (~65%), or in the Sylvian fissure (lateral sulcus (~30%))
24
Q

The sensitivity of CT to the presence of subarachnoid blood is strongly influenced by both the amount of blood and the time since the haemorrhage.

CT head is very sensitive and specify if performed within how many hours from the time of symptom onset

A

Performed within 6 hours

25
Q

If CT is performed > 6 hours from symptom onset, then what investigations must be conducted to exclude the diagnosis of subarachnoid hemorrhage

A

Lumbar puncture

26
Q

When is a lumbar puncture used in investigating subarachnoid haemorrhage

A

Used to confirm SAH if CT is negative, particularly if CT head was performed > 6 hours since the time of symptom onset

27
Q

What are the two features from a lumbar puncture that would be suggestive of a subarachnoid haemorrhage

A

Raised red cell count

Xanthochromia (the yellow colour of CSF caused by bilirubin)

28
Q

When should a patient be referred to neurosurgery for a subarachnoid haemorrhage

A

Referral to neurosurgery to be made as soon as SAH is confirmed

29
Q

What investigation is used once a subarachnoid haemorrhage is confirmed to locate the source of bleeding/ruptured aneurysm

A

CT intracranial angiogram

30
Q

Why is a CT intracranial angiogram important to do once a diagnosis of subarachnoid haemorrhage is made

A

Used once a subarachnoid haemorrhage is confirmed to locate the source of bleeding/ruptured aneurysm

31
Q

Name some of the complications of a subarachnoid haemorrhage

A
  • Re-bleeding – most common in the first 12 hours
  • Cerebral vasospasm (also termed delayed cerebral ischaemia) – typically 7-14 days after onset
  • Hyponatraemia (most typically due to syndrome inappropriate anti-diuretic hormone (SIADH))
  • Seizures
  • Hydrocephalus
  • Death
32
Q

Cerebral vasospasm is a common complication of a subarachnoid haemorrhage.

How long after a subarachnoid haemorrhage would vasospasm typically develop?

A

Typically 7-14 days after onset

33
Q

Rebleeding is the most common complication of a subarachnoid haemorrhage.

How long after a subarachnoid haemorrhage would rebleeding typically occur?

A

Most common in the first 12 hours

34
Q

What is the initial management of subarachnoid hemorrhage

A
  • ABCDE assessment
  • GCS <8 – requires airway management
35
Q

Surgical intervention are used to treat the aneurysms with the aim of repairing the vessel that has caused the subarachnoid hemorrhage to prevent rebleed.

Name the 2 surgical methods to repair the vessels

A

Coiling

Clipping

36
Q

Coiling and clipping are two surgical techiques in which we use to repair the vessels that has caused the subarachnoid hemorrhage.

Which one of these techniques are done under interventional radiology

A

Coiling

37
Q

Coiling and clipping are two surgical techiques in which we use to repair the vessels that has caused the subarachnoid hemorrhage.

Which one of these techniques are done under neurosurgery

A

Clipping

38
Q

What is involved in the coiling surgical technique in manging subarachnoid haemorrhage

A

Done under interventional radiology

Involves inserting a catheter into the arterial system (endovascular approach and placing platinum coils into the aneurysm and sealing it off from the artery

39
Q

What is involved in the clipping surgical technique in manging subarachnoid haemorrhage

A

Done by neurosurgery

Craniotomy and microscopic assisted clipping of the aneurysmal neck

40
Q

A major part of managing subarachnoid haemorrhagic is treating the complications associated with them.

One such complication is cerebral vasospasm. What do we do in order to prevent vasospasm?

A

21 days course of Nimodipine 60mg – one every 4 hours

41
Q

Nimodipine is used to prevent cerebral vasospasm - a complication associated with subarachnoid haemorrhage.

What drug class is it and what is its mechanism of action

A

Calcium channel blocker that targets the brain vasculature

42
Q

A major part of managing subarachnoid haemorrhagic is treating the complications associated with them.

One such complication is hydrocephalus. How do we manage it if this does occur

A

Accumulation of CSF in the ventricular system

Insertion of a shunt to manage the hydrocephalus

43
Q

A major part of managing subarachnoid haemorrhagic is treating the complications associated with them.

One such complication is seizures. How do we manage it if this does occur

A

Antiepileptic medications

44
Q

Coiling and clipping are two surgical techiques in which we use to repair the vessels that has caused the subarachnoid hemorrhage.

Which technique is generally preferred and why?

A

Endovascular clipping is generally preferred over surgical clipping due to better long term survival rates

45
Q

What is the gold standard investigation in assessing for an underlying cause of the subarachnoid haemorrhage?

A

Digital Subtraction Catheter Angiography (DSA)

46
Q

Once a patient is diagnosed with subarachnoid haemorrhage, what is the essential next step (providing that you have already referred them to neurosurgery)

A

CT angiography

finals: medicine (91 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions