Subarachnoid Haemorrhage

Question 1

Where is the subarachnoid space?

Answer 1

between arachnoid and pia mater

Question 2

What is the most common cause of subarachnoid haemorrhage?

Answer 2

Ruptured cerebral aneurysm

Question 3

Give 11 risk factors for subarachnoid haemorrhages:

Answer 3

1) age 45-70
2) female sex
3) black ethnic origin
4) hypertension
5) excessive alcohol intake
6) smoking
7) family history
8) cocaine use
9) sickle cell anaemia
10) connective tissue disorders e.g. Ehlers Danlos or Marfan’s
11) neurofibromatosis

Question 4

Give the typical history of subarachnoid haemorrhage:

Answer 4

thunderclap headache at the occiput that suddenly comes on during strenuous activity e.g. heavy lifting or sex

Question 5

Other than ‘thunderclap headache’ give 6 other symptomatic features of subarachnoid haemorrhages:

Answer 5

1) neck stiffness
2) photophobia
3) vomiting
4) visual changes
5) dysphasia
6) reduced consciousness

Question 6

What is the first line investigation for subarachnoid haemorrhages?

Answer 6

CT head

Question 7

Describe a CT head finding that would confirm subarachnoid haemorrhage diagnosis:

Answer 7

blood can be seen as hyper-attenuation in the subarachnoid space

Question 8

True or false: a normal CT head excludes a subarachnoid haemorrhage

Answer 8

False

Question 9

What investigation is used for subarachnoid haemorrhage if CT head is inconclusive?

Answer 9

lumbar puncture

Question 10

How long should you wait after onset of subarachnoid haemorrhage symptoms before doing a lumbar puncture and why?

Answer 10

12 hours - it takes time for the bilirubin to accumulate in the CSF

Question 11

Give two CSF findings that support diagnosis of subarachnoid haemorrhage:

Answer 11

1) increased red cell count
2) xanthochromia

Question 12

What is xanthochromia?

Answer 12

a yellow colour in CSF caused by bilirubin

Question 13

What investigation can be used to locate the source of bleeding following a diagnosis of subarachnoid haemorrhage?

Answer 13

CT aniography

Question 14

Name two surgical interventions for a ruptured aneurysm in the brain:

Answer 14

1) endovascular coiling
2) neurosurgical clipping

Question 15

Describe the process of endovascular coiling as a treatment of subarachnoid haemorrhage:

Answer 15

inserting a catheter in the arterial system and placing platinum coils in the aneurysm to seal it off from the rest of the artery

Question 16

What drug is used to prevent vasospasm and brain ischaemia during subarachnoid haemorrhages?

Answer 16

nimodipine

Question 17

What is hydrocephalus?

Answer 17

increased CSF causing expansion of the ventricles (a common complication of subarachnoid haemorrhages)

Question 18

Give 3 treatments of hydrocephalus:

Answer 18

1) lumbar puncture
2) external ventricular drain
3) ventriculoperitoneal shunt

Question 19

What is an external ventricular drain?

Answer 19

a drain inserted into the brain ventricles to remove CSF

Question 20

What is a ventriculoperitoneal shunt?

Answer 20

a catheter connecting the ventricles with the peritoneal cavity