Subarachnoid Haemorrhage Flashcards

1
Q

What is it?

A

Bleeding in to the Subarachnoid Space

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2
Q

What causes it? (4)

A
  1. Berry Aneurysm rupture usually at the posterior communicating artery
  2. Trauma
  3. Arteriovenous Malformations
  4. No cause in 15%
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3
Q

Are they common?

A

Not really, affects 9 in 100,000 people per year, only 25% of thunderclap headaches in primary care are SAH

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4
Q

Who does it affect?

A

More common in women (3:2), typical age of onset is 35-63 years old

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5
Q

What are the risk factors? (7)

A

Smoking, alcohol misuse, hypertension, bleeding disorders, reduced oestrogen post menopause, pathology of the elastic lamina, connective tissue disorders

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6
Q

Symptoms (9)

A

Sudden severe occipital headache, vomiting, collapse, seizures, coma, neck stiffness, dizziness, visual loss, dysphasia

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7
Q

Signs (2)

A

Kernig’s Sign (can’t flex hip and straighten leg), retinal/subhyaloid and vitreous bleeds

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8
Q

Are there any warning signs?

A

Yes, people can have small bleeds prior to a large one called ‘Sentinel’ Bleeds

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9
Q

Differentials (4)

A

Meningitis, Migraine, Cluster headache, Tension headache

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10
Q

Investigations (5)

A

CT, MRI, Lumbar Puncture (may show blood or xanthochromic), CT Angiography, ECG

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11
Q

Treatment (8)

A

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

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12
Q

Complications (4)

A

Death (50%), cerebral ischaemia, epilepsy, re-bleeding

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13
Q

Is there a good prognosis?

A

46% have long term impairments that affect Quality of Life, 60% report frequent headaches, *long term prognosis depends on initial presentation

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