Subarachnoid Haemorrhage

Question 1

What is a subarachnoid haemorrhage?

Answer 1

Subarachnoid haemorrhage is bleeding into the subarachnoid space. That is the space between the arachnoid mater and the pia mater. It is often catastrophic

Question 2

What is the typical age of someone presenting with subarachnoid haemorrhage?

Answer 2

35-65 yrs

Question 3

What are the causes of a subarachnoid haemorrhage??

Answer 3

• rupture of saccular aneurysm (berry aneurysm usually in circle of willis) (80%)
• arteriovenous malformations (15%)

Question 4

What are the risk factors of a subarachnoid haemorrhage?

Answer 4

• smoking
• alcohol
• hypertension
• bleeding disorders
• post menopausal (decreased oestrogen)

Question 5

What are the symptoms of a subarachnoid haemorrhage?

Answer 5

• Sudden
• SEVERE headache (thunderclap)
• site = occipital
• vomiting
• collapse
• siezures
• coma / drowsiness

Question 6

What are the signs of a subarachnoid haemorrhage?

Answer 6

• Neck stiffness (miningism)
• positive kernig’s sign
• retinal bleed
• cranial nerve palsies

Question 7

what is a positive kernig’s sign?

Answer 7

when patient is lying flat, with hip flexed to 90’ the knee will not be able to fully extend. This is a sign of meningism.

Question 8

What are the differentials of subarachnoid haemorrhage

Answer 8

• meningitis
• migraine
• intracerebral bleed
• cortical vein thrombosis

Question 9

What is a sentinel headache?

Answer 9

Patients with subarachnoid haemorrhage may have had a warning headache due to a leaking aneurysm.

Question 10

What invx should be done for a subarachnoid haemorrhage?

Answer 10

• CT

- Lumbar puncture CSF aspirate (will be bloody early on then yellow (xanthochromia) later due to break down of Hb)

Question 11

How is a patient with subarachnoid haemorrhage managed?

Answer 11

1) SEND TO NEUROSURGERY NOW!
2) Re-examine CNS, BP, pupils, GCS
3) Maintain cerebral perfusion (keep well hydrated)
4) Nimodipine (to reduce vasospasm —-> reduce cerebral ischaemia)
5) Endovascular coiling

Question 12

What are the complications of subarachnoid haemorrhage?

Answer 12

• rebleeding
• cerebral ischaemia
• hydrocephalus
• hyponatraemia

Question 13

why is nimodipine (Ca2+ channel blocker) given to patients with subarachnoid haemorrhage?

Answer 13

Nimodipine acts to reduce vasospasm therefor reduces risk of cerebral ischaemia.