Subarachnoid haemorrhage

Question 1

What is usually the cause?

Answer 1

Ruptured cerebral aneurysm

Question 2

What are risk factors?

Answer 2

Aged 45-70
Women
Black ethnic origin
HTN
Smoking
Excessive alcohol
FHx
Cocaine use
Sickle cell anaemia
Connective tissue disorders
Neurofibromatosis
Autosomal dominant PKD

Question 3

What is presentation?

Answer 3

Sudden onset occipital headache
Usually during strenuous activity
Thunderclap
Neck stiffness
Photophobia
Vomiting
Neuro sx

Question 4

What are investigations

Answer 4

CT head - hyperattenuation in the subarachnoid space
Lumbar puncture if CT head normal
shows raised RCC and xanthochromia
CT angiography to locate source of bleeding

Question 5

When does CT head become less reliable?

Answer 5

6 hours after start of symptoms

Question 6

When should LP be performed?Why?

Answer 6

At least 12 hours after the symptoms start as this is how long it takes for bilirubin to accumulate in CSF

Question 7

What is management?

Answer 7

Surgical intervention for aneurysms with endovascular coiling or neurosurgical clipping
Nimodipine to prevent vasospasm as vasospasm can result in brain ischaemia

Question 8

How is hydrocephalus - a complication - managed/

Answer 8

LP
External ventricular drain
VP shunt