Subarachnoid Haemorrhage Flashcards
The Treatment of a traumatic SAH is?
Decompressive craniotomy
According to the updated NICE guidelines, what is the ideal Door to CT time for any head injury?
60 minutes
What are the 3 most common locations for a Berry aneurysm?
List 4 RF for Berry Aneurysm
Most common =
ACA and Anterior communicating artery junction
MCA Bifurcation
ICA and Posterior cerebral artery junction
List the causes of SAH
What drugs increase the risk of SAH?
Sympathomimetics (Cocaine, Methamphetamines)
Anti-coagulants
Vasodilators (CCB, PDE-5 inhibitors e.g. sildenafil)
What sign on examination (not GCS or vitals) would indicate raised ICP?
Papilloedema (on fundoscopy)
What are the clinical features a/w SAH?
for Sx of ICP use this inctead:
1) Altered conciousness (GCS, confusion +/- Coma)
2) headache worse when lying flat/in morning),
3) N+V,
4) Blurred vision + Diplopia
5) Coma
6) Dizziness and light headedness (syncope but not syncope?)
Herniation =>
1) Cushing’s Triad: HTN, Bradycardia, Irregular resp (e.g. Cheyne Stokes breathing)
2) Cardio-resp compromise
3) CN palsies
4) Focal Neurological deficits
List the diagnostic investigations used for SAH
1) Non-contrast CT Brain -> CT angiogram
2) Lumbar puncture
3) Cerebral Catheter Angiography
With a non-contrast Ct brain, sensitivity deminishes with time from 90% at Day 1 to 50% after one week. Why does this occur?
What findings on Non-contrast CT brain would indicate an SAH?
As time passes, the blood coagulates and is slowly reabsorbed => becomes isodense with brain tissue on Non-contrast CT
What are the 2 main reasons CT angiography is performed in the setting of SAH?
1) Determine location, position, size, and morphology in order to decide on the management approach
2) Assess risk of rebleeding/regrowth after tx
What is the risk of rebleeding for SAH?
When is the risk highest?
40% within 4-weeks, peak at 1 week
When is a lumbar puncture indicated in the setting of SAH?
What would you be looking for
1) CT brain -ve but high suspicion
2) 12 hours after symptom onset
Xanthochromia => 12 hours was to allow for RBC catabolism and hence causing the yellow discolouration
What are the main definitive management options for SAH?
How would you decide which to use?
1) IR Aneurysm coiling - Uncomplicated aneurysms (e.g. good morphology, location, position, and size)
2) Neurosurgical clipping - difficult aneurysms
(Technically also watchful waiting but not a definitive tx)
Vasospasm is an important complication of SAH and its tx. What is the treatment?
Hydration Nimodipine (Dihydropyridine CCB)
Explain the procedure of Aneurysm coiling
What followup regimen would be used?
What are the specific complications?
Explain the procedure of neurosurgical clipping
Can IR treat non-traumatic SAH?
Yes
What are the treatment options of hydrocephalus?
LP (controversial)
External ventricular drain
VP shunt
Simplified algorithm for SAH ->
What is the full management of SAH?
only list
1) ABCDE w/ Primary, secondary and tertiary assessment as per the ATLS protocols
2) Definitive: Coil vs clip
3) Hydrocephalus -> LP, VP shunt, External drain
4) Vasospasm: Hydration + Nimodipine
