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Year Two - Neurology System > Subarachnoid Haemorrhage > Flashcards

Subarachnoid Haemorrhage Flashcards

1
Q

What is a subarachnoid haemorrhage?

A

It is an intracranial haemorrhage within the subarachnoid space, which is located between the pia mater and the arachnoid membrane

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2
Q

What are the seven causes of subarachnoid haemorrhage?

A

Berry Aneurysm Rupture

Arteriovenous Malformation

Cerebral Trauma

Pituitary Apoplexy

Arterial Dissection

Mycotic Aneurysms

Perimesencephalic

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3
Q

What is the most common cause of subarachnoid haemorrhages?

A

Berry aneurysm rupture

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4
Q

What are berry aneurysms?

A

They are aneurysms located within the Circle of Willis

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5
Q

In which three junctions do berry aneurysms tend to form?

A

Between the posterior communicating artery and the internal carotid artery

Between the anterior communicating artery and the anterior cerebral artery

At the bifurcation of the middle cerebral artery

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6
Q

What four conditions are associated with berry aneurysms?

A

Autosomal Dominant Adult Polycystic Kidney Disease

Ehler’s Danlos Syndrome

Aorta Coarctation

Hypertension

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7
Q

What are the eight risk factors of subarachnoid haemorrhage?

A

Female Gender

Older Age 45 – 70

Black Ethnicity

Family History

Hypertension

Sickle Cell Anaemia

Smoking

Cocaine Use

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8
Q

What are the nine clinical features of subarachnoid haemorrhage?

A

Thunderclap Headache

Nausea & Vomiting

Neck Stiffness

Photophobia

Diplopia

Slurred Speech

Unilateral Weakness

Loss of Consciousness

Seizures

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9
Q

What is the most common clinical feature associated with subarachnoid haemorrhages?

A

Thunderclap headache

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10
Q

What is thunderclap headache? How long does it take to reach maximum intensity?

A

It refers to a sudden onset, severe occipital headache

The headache reaches maximum intensity within one minute

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11
Q

What tends to onset thunderclap headaches?

A

Strenuous activity, such as physical exercise or sexual intercourse

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12
Q

What four investigations are used to diagnose subarachnoid haemorrhages?

A

Non-Contrast CT scans

Lumbar puncture

CT intracranial angiography

ECG Scan

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13
Q

What is the first line investigation used to diagnose subarachnoid haemorrhages?

A

Non-Contrast CT scan

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14
Q

What feature on CT scans indicates a diagnosis of subarachnoid haemorrhage?

A

Hyperdense material (blood) within the subarachnoid space

In most cases, this is apparent within the circle of Willis region, in which berry aneurysms occur - involving the basal cisterns, sulci and in severe cases the ventricular system

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15
Q

What is the most appropriate next step in cases where a CT scan is conducted within 6 hours of clinical features and results are normal, however clinical history is suggestive of subarachnoid haemorrhage?

A

Do not conduct a lumbar puncture

Consider an alternative diagnosis

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16
Q

What is the most appropriate next step in cases where a CT scan is conducted after 6 hours of clinical features and results are normal, however clinical history is suggestive of subarachnoid haemorrhage?

A

Lumber Puncture

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17
Q

What is a lumbar puncture?

A

It involves obtaining a sample of CSF by inserting of a needle into the subarachnoid space of the spinal cord, specifically between L3 and L4 vertebrae

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18
Q

What four lumbar puncture features indicate a diagnosis of subarachnoid haemorrhage?

A

Increased Red Cell Count

Increased Bilirubin Levels

Xanthochromia

Increased Opening Pressure

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19
Q

What is xanthochromia? What is the cause?

A

It is yellow CSF sample

This is due to bilirubin build up

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20
Q

What is a traumatic tap?

A

This is the introduction of blood into CSF samples due to the lumbar puncture procedure

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21
Q

What distinguishes true subarachnoid haemorrhage from a traumatic tap?

A

Xanthochromia

22
Q

When should lumbar punctures be conducted when used to diagnose subarachnoid haemorrhage? Why?

A

12 hrs > headache onset

This allows time required for the RBCs to breakdown and produce xanthochromia

23
Q

What is CT intracranial angiography?

A

It involves the conduction of a head CT scan, with an intravenous contrast, in order to highlight the cerebral arteries and investigate the formation of blood clots

24
Q

When are CT intracranial angiography conducted in subarachnoid haemorrhage patients? Why?

A

This investigation is conducted once a diagnosis of subarachnoid haemorrhage has been confirmed

In order to identify a causative pathology, that may require urgent treatment

25
Q

What is the feature of subarachnoid haemorrhage on ECG scans?

A

ST elevation

26
Q

What are the two pathophsyiological causes of ST elevation in subarachnoid haemorrhage?

A

It is secondary to either autonomic neural stimulation from the hypothalamus

It is secondary to elevated levels of circulating catecholamines

27
Q

What two supportive management options are used in subarachnoid haemorrhage patients?

A

Fluid management

Intubation and ventilation - in patients with a reduced consciousness

28
Q

What two pharmacological management options are used in subarachnoid haemorrhage patients?

A

Nimodipine

Anticonvulsants

29
Q

What is the mechanism of action of nimodipine?

A

It is a calcium channel inhibitor which targets cerebral vasculature

30
Q

Why do we prescribe subarachnoid haemorrhage patients nimodipine?

A

To prevent vasospasm, which is a common complication following subarachnoid haemorrhage that can result in brain ischaemia

31
Q

How long do we usually prescribe nimodipine to subarachnoid haemorrhage patients?

A

3 weeks

32
Q

When are anticonvulsants used to treat subarachnoid haemorrhage patients?

A

In cases where seizure development occurs

33
Q

What anticonvulsant is commonly prescribed?

A

Phenytoin

34
Q

What four surgical procedures are used to treat subarachnoid haemorrhage?

A

Endovascular Coiling

Surgical Clipping

Lumbar Puncture

External Ventricular Drain

35
Q

When is endovascualr coiling selected as the subarachnoid haemorrhage treatment?

A

When the underlying pathology is related to a berry aneurysm

36
Q

What is endovascular coiling?

A

It involves the insertion of a catheter into the femoral artery, which is then guided to the cerebral arteries containing the aneurysm

Platinum coils are then passed through the catheter and into the aneurysm, resulting in separation of the aneurysm from the main artery, and therefore prevention of further rupture

37
Q

When is surgical clipping selected as the subarachnoid haemorrhage treatment option?

A

When the underlying pathology is related to a berry aneurysm

38
Q

What is surgical clipping?

A

It involves the conduction of a craniotomy and the placement of metal clip around the base of the aneurysm to separate the aneurysm from the main artery, preventing further rupture

39
Q

How do we decide which procedure to conduct - endovascualr coiling or surgical clipping?

A

It is dependent on the location, shape and size of the aneurysm

40
Q

What procedure is preferred - endovascualr coiling or surgical clipping? Why?

A

Endovascular coiling

A reduced risk of short term complications and shorter recovery times

41
Q

How soon should intracranial aneurysms be treated? Why?

A

Within 24 hours

Due to the risk of re-bleeding

42
Q

What are the three conservative measures that can be used to prevent aneurysm re-bleeding until surgical management is arranged?

A

Bed rest

Blood pressure control

Avoid straining

43
Q

What is an external ventricular drain procedure?

A

It involves the insertion of a catheter into the frontal lobe of the brain where the lateral ventricles are situated, enabling drainage of CSF into an external collecting system

44
Q

When is lumbar puncture and external ventricular drain procedures used to treat subarachnoid haemorrhages?

A

When hydrocephalus complications have developed

45
Q

What six complications are associated with subarachnoid haemorrhage?

A

Aneurysm Re-Bleeding

Vasospasm

Hyponatraemia

Seizures

Hydrocephalus

Torsades de Pointes

46
Q

What is the cause of hyponatraemia in subarachnoid haemorrhage patients?

A

SIADH

47
Q

What are the four clincial features of SIADH?

A

Drowsiness

Nausea

Headache

Muscle Cramps

48
Q

Which blood test is most important to conduct in order to monitor complications? Explain

A

U&Es

This is due to the fact that hyponatraemia is a common complication

49
Q

How soon after subarachnoid haemorrhage does aneurysm re-bleeding usually occur?

A

Within 12 hours

50
Q

How soon after subarachnoid haemorrhage does vasospasm usually occur?

A

7-12 days

51
Q

What are the three predictive factors of subarachnoid haemorrhage?

A

Conscious Level on Admission

Age

Blood Volume Visible on CT Head

Year Two - Neurology System (25 decks)

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