Subarachnoid Haemorrhage Flashcards
What is subarachnoid the result of?
Ruptured cerebral aneurysm
What are the risk factors for SAH?
It is more common in:
Aged 45 to 70
Women
Black ethnic origin
General risk factors include:
Hypertension
Smoking
Excessive alcohol intake
What is SAH particularly associated with?
Family history
Cocaine use
Sickle cell anaemia
Connective tissue disorders (e.g., Marfan syndrome or Ehlers-Danlos syndrome)
Neurofibromatosis
Autosomal dominant polycystic kidney disease
What is the presentation of SAH?
Sudden occipital headache
Also:
Neck stiffness
Photophobia
Vomiting
Neurological symptoms (e.g., visual changes, dysphasia, focal weakness, seizures and reduced consciousness)
What investigations should be done?
CT head = first line
-less reliable more than 6 hours after the start of symptoms
Lumbar puncture after a normal CT head
CT angiography
When should lumbar puncture be done?
Wait at least 12 hours after symptoms start.
Why should you wait this long?
Takes time for bilirubin to accumulate in CSF
What will you see on LP?
Raised red cell count
Xanthochromia (yellow colour to CSF due to bilirubin)
What is the management of SAH?
Surgical intervention to treat aneurysm
Nimopidine
How is surgical intervention done?
By Endo vascular coiling
Or neurosurgical clipping
What is nimopidine?
A calcium channel blocker
What does nimopidine do?
Prevent vasospasm
What is a complication in SAH?
Hydrocephalus
How can you treat complication?
LP
External ventricular drain
Ventriculoperitoneal shunt
How are seizures treated?
With anti-epileptic drugs
