Subarachnoid haemorrhage Flashcards
Causes
Most common is traumatic
Intracranial aneurysm
AV malformation
Pituitary apoplexy
Arterial dissection
Mycotic (infective aneurysms)
Perimesencephalic
Presenting features
Sudden onset, severe, occipital headache
Nausea and vomiting
Meningism
Coma
Seizures
Sudden death
Confirmation of SAH
CT head
- hyperdense blood distributed in basal cisterns, sulci and ventricular system
LP
- used to confirm SAH if CT is negative
- 12 hours following onset of symptoms
LP findings
Xanthochromia (12 hours after as thats the time needed for RBC breakdown)
Normal or raised opening pressure
Treatment
Aneurysm- prompt intervention; coil; strict bed rest until then
Hydrocephalus- external ventricular drain
Complications of aneurysmal SAH
Rebleeding (most common in first 12 hours)
Vasospasm (7-14 days after)
Hyponatraemia (due to SIADH)
Seizures
Hydrocephalus
Death
Predictive factors in SAH
Conscious level on admission
Age
Amount of blood visible on CT head