Subarachnoid Haemorrhage

Question 1

Causes of spontaneous SAH

Answer 1

Intracranial aneurysm, AV malformation, pituitary apoplexy, mycotic aneurysms

Question 2

Most common cause of SAH

Answer 2

Trauma

Question 3

Features of headache in SAH

Answer 3

Sudden onset, severe, occipital, worse ever, peaking intensity at 1-5 minutes

Question 4

Symptoms of SAH

Answer 4

Nausea and vomiting, meningism (photophobia, neck stiffness), coma, seizures

Question 5

ECG findings in SAH

Answer 5

ST elevation, secondary to autonomic neural stimulation from the hypothalamus or elevated levels of circulating catecholamines

Question 6

Investigation into SAH

Answer 6

Non-contrast CT head is first line

Question 7

When is an LP performed

Answer 7

At least 12 hours following onset of symptoms to allow development of xanthochromia

Question 8

Investigations to carry out once spontaneous SAH is confirmed

Answer 8

CT intracranial angiogram with or without digital subtraction angiogram

Question 9

Management of confirmed aneurysmal subarachnoid haemorrhage

Answer 9

Supportive including bet rest, VTE prophylaxis, discontinuation of antithrombotics.
Prevent vasospasm by using oral nimodipine.
Intervention within 24 hours as may rebleed -> coil

Question 10

Complications of aneurysmal SAH

Answer 10

Re-bleeding, hydrocephalus, vasospam 7-14 days after onset, hyponatraemia, seizures