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Z Year3 Neuro Conditions > Subarachnoid Haemorrhage > Flashcards

Subarachnoid Haemorrhage Flashcards

1
Q

How common is subarachnoid haemorrhage?

A
  • Accounts for 5% of all strokes

- Incidence 9/100,000/yr

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2
Q

What is the typical age of subarachnoid haemorrhage?

A

age 35-65

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3
Q

What are RF for subarachnoid haemorrhage?

A
  1. Hypertension
  2. Smoking
  3. FHx
  4. Autosomal dominant polycystic kidney disease (ADPKD)
  5. Age over 50
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4
Q

What is the most common cause of subarachnoid haemorrhage?

A

rupture of intracranial saccular aneurysm is leading cause of non-traumatic SAH (80% cases) – BERRY ANEURYSM RUPTURE

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5
Q

What are common sites of berry aneurysm?

A
  1. junctions of posterior communicating with internal carotid
  2. anterior communicating artery with anterior cerebral artery
  3. bifurcation of middle cerebral artery
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6
Q

What are the other causes of SAH?

A
  1. Arterio-venous malformations (AVM) (15%)
  2. Encephalitis
  3. Vasculitis
  4. Tumour
  5. Idiopathic
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7
Q

What are headache of SAH like and timings?

A
  1. Sudden severe headache
  2. Thunderclap headache
  3. Peaks in 1-5min and lasts more than 1hr
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8
Q

What are the associated features of SAH?

A
  1. Vomiting
  2. Photophobia
  3. Non-focal neurological signs
  4. Neck stiffness and muscles aches (meningisumus)
  5. Depressed consciousness/loss of
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9
Q

What are possible DDx for SAH?

A
  1. Non-aneurysmal peri mesencephalic SAH
  2. Arterial dissection
  3. Cerebral and cervical AVM
  4. Dual AVF
  5. Vasculitis
  6. Septic aneurysm etc
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10
Q

What tests do you do for SAH?

A
  1. Emergency non contrast CT head within 12hr
  2. If CT neg or inconclusive order LP
  3. Cerebral angiography to identity causal pathology
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11
Q

What would a non contrast CT head show in SAH?

A

hyperdense areas in the subarachnoid space/basal cisterns look for hyper-attentuation around circle of willis

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12
Q

When do you order a LP?

A

at least 12 hr after onset of symptoms

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13
Q

Why do you have to wait for LP?

A

12hr so allow breakdown of RBC so positive sample is xanthrochromic+oxyhaemoglobin (yellow due to bilirubin differentiated between old blood from SAH vs bloody tap

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14
Q

What bloods do you order for SAH?

A
  1. FBC: may show leukocytosis
  2. Serum Electrocytes: can show severe hypoatraemia
  3. Clotting profile: can show elevated INR, prolonged PTT
  4. Troponin I: may be elevated
  5. Serum glucose: may be elevated
  6. ECG: arrhythmias, prolonged QT, ST segment, or T wave abnormalities
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15
Q

What would the FBC show in SAH?

A

may show leukocytosis

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16
Q

What would serum electrolytes show in SAH?

A

can show severe hypoatraemia

17
Q

What would clotting profile show in SAH?

A
  • can show elevated INR

- prolonged PTT

18
Q

What would troponin I and Serum glucose be like in SAH?

A

maybe elevated

19
Q

What would ECG be like in SAH?

A
  1. arrhythmias
  2. prolonged QT
  3. ST segment
  4. T wave abnormalities
20
Q

What the 1st line treatment if GCS <8 or falling?

A

stabilise and investigation same time - cardiopulmonary support

21
Q

How else would you manage SAH with GCS <8 or falling?

A
  1. nimodipine as soon as diagnosis confirmed (prevent delayed cerebral ischaemia) – Ca2+ antagonist
  2. supportive care and monitoring
22
Q

What is the 1st line trestment for SAH if the GCS>9?

A

supportive care and monitoring and nimodipine

23
Q

What else would you consider for management of SAH with GCS>9?

A
  • anticonvulsant
  • Analgesia
  • Stop and reverse anticoagulation
  • Anti-emetic
  • endovascular coiling or surgical clipping
  • ventriculostomy or lumbar draining of CSF
24
Q

What is the treatment of ongoing SAH with symptomatic vasospasm of SCI?

A

referral to neurosurgeon

25
Q

What are possible complications of SAH?

A
  1. Neuropsychiatric problems
  2. Chronic hydrocephalus
  3. Rebleeding: 20%
  4. Cerebral ischaemia due to vasospasms
  5. Hydrocephalus due to blockage of arachnoid granulations require ventricular or lumbar drain
  6. Hypoatraemia
26
Q

What is the prognosis of SAH?

A

diagnosing and securing aneurysm within 48hr associated with lower risk of rebleeding and lower disability rates

27
Q

Why is nimodipine given in SAH?

A

prevent delayed cerebral ischaemia

28
Q

What do you need to review for SAH?

A
  • anticoagulant medications
    1. Anticoagulants and antithrombotic drugs can make bleeding worse
    2. Discontinued or reverse
    3. Contact GP to change medications
29
Q

What is SAH most commonly due to?

A

rupture of a saccular aneurysm

Z Year3 Neuro Conditions (34 decks)

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