Subarachnoid haemorrhage Flashcards
Causes of spontaneous SAH
- intracranial aneurysm (saccular ‘berry’ aneurysms)
conditions associated with berry aneurysms:
- HTN
- polycystic kidneys
- Ehlers Danlos
- Coarctation of Aorta
- AVM
Pituitary apoplexy
Mycotic (infective) aneurysm
Presenting symptoms in SAH
- sudden-onset ‘thunderclap’ occipital headache
- peaking in intensity within 1 to 5 minutes
- N+V
- meningism (photophobia, neck stiffness)
- coma
- seizures
Why are ECG changes sometimes seen in SAH?
secondary to either autonomic neural stimulation from the hypothalamus or elevated levels of circulating catecholamines
- sometimes can show ST elevation
INvestigation of suspected SAH
- non-contrast CT head
- LP if CT done >6hrs after symptom onset
LP findings in SAH
xanthochromia - 12hrs post symptom onset
normal or raised opening pressure
Imaging which will identify causative pathology
CT intracranial angiogram (to identify a vascular lesion e.g. aneurysm or AVM)
+/- digital subtraction angiogram (catheter angiogram)
Management of confirmed SAH due to aneurysm
- supportive/ analgesia
- VTE prophylaxis
- reverse anticoagulation
- vasospasm is prevented using a course of oral nimodipine
- neurosurgery/interventional neuroradiology input for coiling
Complications of SAH
re-bleeding
hydrocephalus
vasospasm
hyponatraemia (SIADH)
seizures