Subarachnoid Haemorrhage Flashcards
what is a subarachnoid haemorrhage
bleeding into subarachnoid space between the arachnoid and Pia maters
aka where CSF is
usually caused by a cerebral aneurysm
how does a sub-arachnoid haemorrhage present
sudden onset of thunderclap headache
pain is maximal at onset of headache
can also present with seizures, confusion, n and v, neck stiffness, photophobia
what are the risk factors of a subarachnoid haemorrhage
Hypertension
Smoking
age
FH
polycystic kidney disease
alcohol excess
how do you investigate a sub arachnoid haemorrhage
Non-contrast ct scan is first line
LP if CT is clear and done 6 hours after symptoms- high RBCs if soon or bilirubin if they have been metabolised (xanthochromia)
ECG may show arrhythmia or ST elevations
how do you manage a subarachnoid haemorrhage
immediate referral to neurosurgery and intervention should be in 24 hrs
1st line:
- nimodipine to prevent vasospasm (calcium channel blocker)
- endovascular clipping
2nd line:
- surgical clipping via a craniotomy
