subarachnoid Haemorrhage

Question 1

Subarachnoid haemorrhage involves bleeding in to the subarachnoid space, where the ______________ is located, between the ……. what

Answer 1

Subarachnoid haemorrhage involves bleeding in to the subarachnoid space, where the cerebrospinal fluid is located, between the pia mater and the arachnoid membrane.

Question 2

subarachnoid haemorrhage is usually the result of a ruptured?

Answer 2

This is usually the result of a ruptured cerebral aneurysm.

Question 3

how deadly are subarachnoid haemorrhages?

Answer 3

Subarachnoid haemorrhage has a very high mortality and morbidity. It is very important not to miss the diagnosis and you need to have a low suspicion to trigger full investigations.

Question 4

subarachnoid haemorrhage should be discussed with who?

Answer 4

It needs to be discussed with the neurosurgical unit with a view to surgical intervention.

Question 5

what is a thunderclap headache

Answer 5

The typical history is a sudden onset occipital headache that occurs during strenuous activity such as weight lifting or sex. This occurs so suddenly and severely that it is known as a “thunderclap headache”. It is described like being hit really hard on the back of the head.

Question 6

as well as thunderclap headaches, what are the other factors of subarachnoid haemorrhage

Answer 6

Neck stiffness
Photophobia
Vision changes
Neurological symptoms such as speech changes, weakness, seizures and loss of consciousness

Question 7

risk factors of subarachnoid haemorrhage

Answer 7

Hypertension
Smoking
Excessive alcohol consumption
Cocaine use
Family history

Question 8

Subarachnoid haemorrhage is more common in:

Answer 8

Subarachnoid haemorrhage is more common in:

Black patients
Female patients
Age 45-70

Question 9

subarachnoid haemorrhage is particularly associated with:

Answer 9

Cocaine use
Sickle cell anaemia
Connective tissue disorders (such as Marfan syndrome or Ehlers-Danlos)
Neurofibromatosis
Autosomal dominant polycystic kidney disease

Question 10

investigations for subarachnoid haemorrhage. what might you see?

Answer 10

CT head is the first line investigation. Immediate CT head is required. Blood will cause hyperattenuation in the subarachnoid space.

Question 11

might a CT head be normal for a subarachnoid haemorrhage?

Answer 11

yes - so it doesn’t rule it out. follow with LP

Question 12

describe lumbar puncture in subarachnoid haemorrhage

Answer 12

Lumbar puncture is used to collect a sample of the cerebrospinal fluid if the CT head is negative. CSF can be tested for signs of subarachnoid haemorrhage:

Red cell count will be raised. If the cell count is decreasing in number over the samples, this could be due to a traumatic lumbar puncture.
Xanthochromia (the yellow colour of CSF caused by bilirubin)

Question 13

describe the RBC counts in traumatic LP

Answer 13

red cell counts are initially raised, but decrease over the samples.

Question 14

what do we test for in LP for subarach?

Answer 14

red cell count
Xanthochronia

Question 15

how do we confirm the source of the bleeding in subarachnoid haemorrhage

Answer 15

Angiography (CT or MRI) can be used once a subarachnoid haemorrhage is confirmed to locate the source of the bleeding.

Question 16

where are subarachnoid haemorrhages treated?

Answer 16

Patients should be managed by a specialist neurosurgical unit. Patients with reduced consciousness may require intubation and ventilation. Supportive care as part of a multi-disciplinary team is important with good nursing, nutrition, physiotherapy and occupational therapy involved during the initial stages and recovery.

Question 17

what surgical interventions are available for subarachnoid haemorrhage

Answer 17

Surgical intervention may be used to treat aneurysms. The aim is to repair the vessel and prevent re-bleeding. This can done by coiling, which involves inserting a catheter into the arterial system (taking an “endovascular approach”), placing platinum coils into the aneurysm and sealing it off from the artery.
An alternative is clipping, which involves cranial surgery and putting a clip on the aneurysm to seal it.

Question 18

what is vasospasm?

Answer 18

Vasospasm is a common complication that can result in brain ischaemia following a subarachnoid haemorrhage.

Question 19

what drug can prevent vasospasm

Answer 19

Nimodipine is a calcium channel blocker that is used to prevent vasospasm

Question 20

hydrocephalus as a complication of subarachnoid haemorrhage - how can we manage that?

Answer 20

Lumbar puncture or insertion of a shunt may be required to treat hydrocephalus.

Question 21

are seizures a complication of subarachnoid haemorrhage

Answer 21

Antiepileptic medications can be used to treat seizures.