Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Subarachnoid Haemorrhage > Flashcards

Subarachnoid Haemorrhage Flashcards

1
Q

What is the most common type of SAH?

A

Aneurysmal - local dilation of the artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the aetiology of an aneurysmal SAH.

A

Incidence - 8/100,000
Age of presentation: 40-60
3% of all strokes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes aneurysm formation in an aneurysmal SAH?

A

Haemodynamic stress
Extensive inflammatory and immunological reactions are common in unruptured intracranial aneurysms and may be related to aneurysm formation and rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe formation of aneurysms.

A

Increased haemodynamic stress on blood vessels normally involves equal outward vascular growth.
In maladaptive vascular remodelling, there is only focal activation of growth.
- only a small area of the blood vessel increases in size
- an aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which arteries cause SAH when they rupture?

A

Cerebral arteries

  • anterior
  • middle
  • posterior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the non-aneurysmal causes of an SAH?

A 
AVM - arteriovenous malformation
Neoplasia 
No identifiable cause
- angiogram negative 
- follow a benign course
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the predisposing risk factors for aneurysmal SAH?

A 
Smoking
Female sex
Hypertension
Positive family history
ADPCK (polycystic kidney disease)
Ehlers Danlos (connective tissue syndrome)
Coarctation of the aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What history would you expect from someone with a SAH?

A 
Sudden onset, high intensity (thunderclap) headache
Loss of consciousness
Seizures
Visual, speech and limb disturbances
Sentinel headache 
- headache precedes SAH by days/weeks
- small SAH bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do you expect to see on clinical examination if someone has a SAH?

A 
Photophobia 
Meningism
Subhyaloid haemorrhages
Vitreous heamorrhage
Speech and limb disturbance 
Pulmonary oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the WFNS grading system in SAH prognosis.

A

Grade 1 - GCS 15
Grade 2 - GCS 13/14 with no neurological deficit
Grade 3 - GCS 13/14 with neurological deficit
Grade 4 - GCS 7/12
Grade 5 - GCS 3/6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why do you need to do a CT on someone with an SAH?

A

Confirms the diagnosis and shows location of the aneurysm
Identifies complications
- infarction
- haematoma
- hydrocephalus (CSF accumulation)
Allows estimation of prognosis with the Fisher Grade
- predicts risk of vasospasm
- the thicker the haematoma, the worse the prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What investigations are performed if someone has a suspected SAH?

A 
CT
Lumbar Puncture 
CTA
MRA
DSA (digital subtraction angiography) 
- stroke, diabetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you look for in an LP if someone has an SAH?

A

Used when patients have a negtive CT scan
Xanthochromia
- bilirubin in the CSF (yellowing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aside from imaging and xanthochromia, what changes would you see on investigations if a person has an SAH?

A 
Hyponatraemia 
ECG changes 
Elevated troponin levels
Echo - tako tsubo cardiomyopathy 
Easy to mistake for an MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is a person with an SAH immediately treated?

A 
Bed rest
Fluids - 3L of normal saline
Anti-embolic stockings
Nimodipine
- calcium channel blocker
- has a neuro-protective effect
Analgesia 
Doppler studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the three long term methods of management of an SAH?

A

Surgical clipping
Endovascular (coils, stents and glue)
Conservative

17
Q

How are surgical clippings of aneurysms performed?

A

Clips are placed along the base of the aneurysm, preventing flow of blood into it
- no longer under stress and goes down
- excluding the aneurysm
- be careful to to clip the perforating arteries that arise around the aneurysm
CTA performed post-clipping to ensure the clips are in place

18
Q

How are endovascular management of aneurysms performed?

A

Electrically induced thrombosis within the aneursym
Detachable coils to fill and exclude the aneurysm
Stent to divert the blood and allow healing (e.g. WEB device)

19
Q

Which aneurysm requires fenestrated clips during surgical clipping treatment?

A

Anterior communicating artery aneurysm

20
Q

What complications can occur post aneurysm?

A 
Re-haemorrhage
Delayed ischaemia 
Hydrocephalus 
Hyponatraemia
ECG changes
- left ventricular failure (tako-tsubo cardiomyopathy)
Lower respiratory tract infection
UTI
Pulmonary embolism
21
Q

When is risk of re-haemorrhage highest?

A

Immediately after initial bleed
In poor grade patients (lower GCS)
Larger aneurysms
Repair isn’t quick enough

22
Q

If a person develops hydrocephalus, how can they be managed?

A

Temporarily
- LP
- spinal drain
A shunt to allow CSF drainage can be used

23
Q

What complication is most common after occlusion of the aneurysm?

A

Delayed ischaemia

24
Q

What causes delayed ischaemia?

A

Angiographic spasm

- microcirculation shutting down due to release of blood products at the time of haemorrhage

25
Q

How can you recognise delayed ischaemia?

A

Progressive deterioration in loss of consciousness

- associated with a new deficit

26
Q

How is delayed ischaemia managed?

A 
Fluid management
- colloid infusions
Nimodipine
Inotropes
- increases bp to force the blood through the system
Angioplasty (balloon angioplasty)
27
Q

Name some of the causes of hyponatraemia after SAH.

A

Cerebral salt wasting syndrome
- blood around the brain causes the patient to leach sodium and loose water
SIADH
- less common
- increased water retention
Can flip from one to the other, affecting treatment

28
Q

How is a patient with hyponatraemia managed?

A 
Establish the volume status
- decreased in CSWS
- increased in SIADH
CSWS treatement 
- Fludrocortisone
- Hypertonic saline
29
Q

How does SAH cause cardiopulmonary complications?

A

Bleeding and pressure release cause cause widespread catecholamine release
This can damage the heart

30
Q

What heart problems are associated with SAH?

A 
Troponin elevation 
Arrythmias
Wall motion
Sudden death
Tako-tsubo cardiomyopathy 
- clot formation
- poor pumping
31
Q

How do seizures after SAH occur?

A

Blood around the brain irritates the neurons
Often a manifestation of re-rupture
Can be given anti-convulsants

32
Q

Why is DVT prophylaxis needed after SAH?

A

Patients lie prone in bed
SAH induces a prothrombotic state
Difficult because the patient is also bleeding
- anti-thrombotic agents are being used
- safest to use sequential compression devices initially (after the aneurysm is secured)

Neurology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions