Subarachnoid haemorrhage

Question 1

What is a subarachnoid haemorrhage caused by?

Answer 1

Berry aneurysm at anterior communicating artery/ ACA junction rupturing
or trauma

Question 2

What are risk factors for a subarachnoid haemorrhage?

Answer 2

Connective tissue disorders like Marfan and Ehler-Danlos syndrome
Hypertension
Polycystic kidney disease
Age
Trauma
Family history

Question 3

What are symptoms of a subarachnoid haemorrhage?

Answer 3

Occipital thunderclap headache

May have Sentinel headache, precedes berry aneurysm rupture. Throbbing occipital pain.

Meningism (mimics meningitis) with Kernig and Bridzinski signs.

Decreased Glasgow Coma Scale (GCS, less conscious)

Nerve palsies CN 3 (fixed dilated pupil) and 6 (nonspecific sign of raised ICP)

Question 4

What is a thunderclap headache?

Answer 4

Worst headache of life, 0 to 10 severity instantly, sudden onset.

Question 5

What is the Glasgow coma scale out of?

Answer 5

15

Question 6

What does a GCS score of 3 mean?

Answer 6

Unresponsive

Question 7

What does a GCS score of 8 mean?

Answer 7

Comatose

Question 8

What does a GCS score of 15 mean?

Answer 8

Normal

Question 9

What is the Kernig sign?

Answer 9

Used to identify meningitis

Feels pain when extending leg and knee is flexed (lying down)

Question 10

What is Brudzinski sign?

Answer 10

Used to identify meningitis

Hips and knees flex when you lift the neck in attempt to lessen the stretch on the inflamed meninges.

Question 11

How do you differentiate subarachnoid haemorrhage from meningitis?

Answer 11

Meningitis has no thunderclap headache and will most likely present with signs of infection.

Question 12

How do you differentiate subarachnoid haemorrhage from a migraine?

Answer 12

migraine has no meningism (Kernig and Brudzinski sign negative) and no no thunderclap headache

Question 13

What imaging is initially used for a suspected subarachnoid haemorrhage?

Answer 13

CT head scan, expect a star shape

Question 14

If the CT head scan confirms a subarachnoid haemorrhage, what happens next?

Answer 14

A CT angiography is performed to identify the source of the bleeding.

Question 15

If the CT head scan doesn’t confirm a subarachnoid haemorrhage but it is still suspected, what happens next?

Answer 15

Perform a lumbar puncture to analyse the CSF for blood.
Do this 12 hours after suspected start, results most sensitive after this time.

Question 16

What will you see in a lumbar puncture of someone with a subarachnoid haemorrhage?

Answer 16

Xanthochromia = yellowish CSF due to RBC haemolysis

Question 17

How do you treat a subarachnoid haemorrhage?

Answer 17

1st line = neurosurgery involving endovascular coiling

Also give nimodipine (calcium channel blocker, decreases vasospasm and blood pressure)