Subarachnoid Haemorrhage Flashcards
What is it?
Bleeding in to the Subarachnoid Space
What causes it? (4)
- Berry Aneurysm rupture usually at the posterior communicating artery
- Trauma
- Arteriovenous Malformations
- No cause in 15%
Are they common?
Not really, affects 9 in 100,000 people per year, only 25% of thunderclap headaches in primary care are SAH
Who does it affect?
More common in women (3:2), typical age of onset is 35-63 years old
What are the risk factors? (7)
Smoking, alcohol misuse, hypertension, bleeding disorders, reduced oestrogen post menopause, pathology of the elastic lamina, connective tissue disorders
Symptoms (9)
Sudden severe occipital headache, vomiting, collapse, seizures, coma, neck stiffness, dizziness, visual loss, dysphasia
Signs (2)
Kernig’s Sign (can’t flex hip and straighten leg), retinal/subhyaloid and vitreous bleeds
Are there any warning signs?
Yes, people can have small bleeds prior to a large one called ‘Sentinel’ Bleeds
Differentials (4)
Meningitis, Migraine, Cluster headache, Tension headache
Investigations (5)
CT, MRI, Lumbar Puncture (may show blood or xanthochromic), CT Angiography, ECG
Treatment (8)
Refer to neurosurgery for endovascular Coiling (intracranial stents and ballooning is used), re-examine CNS every 15 mins, fluids to maintain cerebral perfusion, Nimodipine (Calcium channel blocker) to reduce vasospasm, Analgesia, Anti-emetic, May require ventilation, ventricular draining to prevent hydrocephalus
Complications (4)
Death (50%), cerebral ischaemia, epilepsy, re-bleeding
Is there a good prognosis?
46% have long term impairments that affect Quality of Life, 60% report frequent headaches, *long term prognosis depends on initial presentation