subarachnoid haemorrhage

Question 1

causes of spontaneous SAH

Answer 1

intracranial aneurysm (berry)
arteriovenous malformation
pituitary apoplexy
mycotic aneurysms

Question 2

presentation of SAH

Answer 2

headache: sudden onset, severe
nausea and vomiting
photophobia and neck stiffness
coma
seizure
ECG ST elevation

Question 3

investigation in SAH

Answer 3

non contrast CT head
- if done within 6 hours and normal consider alternative diagnosis
- if more than 6 hours and normal do LP (after 12 hours)

Question 4

what could LP show after 12 hours in subarachnoid haemorrhage

Answer 4

xanthochromia
- red blood cell breakdown

Question 5

next step investigation in spontaneous SAH

Answer 5

CT intracranial angiogram (identify vascular lesion: aneurysm or AVM)
+/- digital subtraction angiogram

Question 6

management of confirmed aneurysmal subarachnoid haemorrhage

Answer 6

supportive: bed rest, analgesia, VTE prophylaxis
vasospasm prevented: nimodipine
surgery: coil by IR or craniotomy and clipping

Question 7

complications of aneurysmal SAH

Answer 7

re-bleeding
hydrocephalus
vasospasm
hyponatraemia (SIADH)
seizures