Subarachnoid haemorrhage Flashcards

1
Q

Causes of spontaneous SAH

A
  • intracranial aneurysm (saccular ‘berry’ aneurysms)

conditions associated with berry aneurysms:
- HTN
- polycystic kidneys
- Ehlers Danlos
- Coarctation of Aorta
- AVM
Pituitary apoplexy
Mycotic (infective) aneurysm

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2
Q

Presenting symptoms in SAH

A
  • sudden-onset ‘thunderclap’ occipital headache
  • peaking in intensity within 1 to 5 minutes
  • N+V
  • meningism (photophobia, neck stiffness)
  • coma
  • seizures
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3
Q

Why are ECG changes sometimes seen in SAH?

A

secondary to either autonomic neural stimulation from the hypothalamus or elevated levels of circulating catecholamines

  • sometimes can show ST elevation
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4
Q

INvestigation of suspected SAH

A
  1. non-contrast CT head
  2. LP if CT done >6hrs after symptom onset
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5
Q

LP findings in SAH

A

xanthochromia - 12hrs post symptom onset
normal or raised opening pressure

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6
Q

Imaging which will identify causative pathology

A

CT intracranial angiogram (to identify a vascular lesion e.g. aneurysm or AVM)

+/- digital subtraction angiogram (catheter angiogram)

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7
Q

Management of confirmed SAH due to aneurysm

A
  • supportive/ analgesia
  • VTE prophylaxis
  • reverse anticoagulation
  • vasospasm is prevented using a course of oral nimodipine
  • neurosurgery/interventional neuroradiology input for coiling
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8
Q

Complications of SAH

A

re-bleeding
hydrocephalus
vasospasm
hyponatraemia (SIADH)
seizures

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9
Q
A
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