Subarachnoid Haemorrhage

Question 1

What is a subarachnoid haemorrhage?

Answer 1

An intracranial blood defined as blood within the subarachnoid space (between pia mater and arachnoid membrane)

Question 2

What is the common cause of SAH?

Answer 2

• Intracranial aneurysm: ‘berry aneurysms common’
• AV malformation
• Pituitary apoplexy

Question 3

How does SAH present?

Answer 3

• Sudden onset thunderclap headache
• N+V
• Photophobia/neck stiffness
• Coma
• Seizures

Question 4

How is SAH investigated?

Answer 4

• CT head -> if normal within 6 hours of onset, no need for LP
• If CT head done >6 hours after onset, LP needed which should be 12 hours after onset to detect xanthochromia
• If CT shows SAH, refer to neurosurgery

Question 5

How is SAH managed?

Answer 5

Supportive: bed rest, analgesia, discontinue antithrombics
- Oral nimodipine to prevent vasospasm
- Neuroradiology/surgery intervention for coiling/clipping

Question 6

What are the complications of SAH?

Answer 6

• Re-bleeding (repeat CT needed)
• Hydrocephalus (shunt inserted)
• Vasospasm
• Hyponatraemia
• Seizures