Subarachnoid haemorrhage

Question 1

What is the most common cause of a SAH

Answer 1

head injury

Question 2

What are the 2 types of SAH

Answer 2

traumatic
spontaneous

Question 3

What are some causes of spontaneous SAH

Answer 3

intracranial aneurysm- berry - 85% of cases

Arteriovenous malformation

pituitary apoplexy

arterial dissection

mycotic aneurysm

perimesencephalic - idiopathic venous bleed

Question 4

What are some risk factors for developing SAH

Answer 4

smoking
hypertension
alcohol
cocaine
connective tissue diseases
family history

Question 5

Where do most berry aneurysms occur

Answer 5

circle of willis

Question 6

What conditions are berry aneurysms associated with

Answer 6

polycystic kidney disease
connective tissue disorders
coarctation of the aorta

Question 7

What are key diagnostic factors for a SAH

Answer 7

severe sudden onset thunderclap headache

depressed/loss of consciousness

neck stiffness and muscle aches

Question 8

What are other diagnostic factors for SAH

Answer 8

photophobia
nausea/vomiting
confusion

Question 9

What is the first line of investigation

Answer 9

non-contrast CT head
- will show hyperdensity within subarachnoid space which will appear white on the CT

Question 10

What are some other investigations to consider

Answer 10

ECG
BLOODS
- FBC leukocytosis
-clotting profile
-troponin- may be raised
-serum glucose- may be raised

Lumbar puncture- 12 HOURS AFTER ONSET

CT angiography - when SAH confirmed

Question 11

What is management

Answer 11

Cardiopulmonar support

Give prothrombin complex concentrate and IV vitamin K reverse effect of warfarin

PLatinum coil for intracranial aneurysm

NIMODIPINE - post operatively to prevent vasospasm

offer preventative measures

Question 12

What complications are associated with SAH

Answer 12

Re-bleeding
- if suspected repeat CT should be arranged

Vasospasm -
7-14 days after onset
which can lead to ischemia

Hyponatremia - due to SIADH

seizures

hydrocephalus

death