Subarachnoid haemorrhage Flashcards
1
Q
Where does as SAH usually stem from
A
Berry aneurysm in circle of willis
2
Q
What is the cause of an SAH
A
- 85% intracranial arterial aneurysm (rupture of saccular aneurysm)
- 10% non-aneurysmal peri-mesencephalic haemorrhage
- Trauma
- Vascular abnormalities
3
Q
What are the risk factors
A
- HTN
- Atherosclerosis
- Smoking + -OH
- Elastic lamina
- Connective tissue disorder
- Cocaine
- Aneurysm
- PKD
4
Q
What are the symptoms
A
- SUDDEN
- Vom
- Collapse / seizure
- +++ occipital pain ‘ felt like been kicked in back of head’
5
Q
What are the signs
A
- Thunderclap headache
- Kernig’s sign
- Neck stiffness
- Retinal haemorrhage
6
Q
What does it mean if there are pupil changes
A
3rd nerve palsy w. posterior communicating artery
7
Q
What investigations do you perform
A
- CT - detects >90% in 48hrs
- LP if CT -ve and not contraindicated
- CSF - bloody early on, xanthochromia later (bilirubin)
8
Q
What treatment is there for SAH
A
- Maintain cerebral perfusion (aim SBP >160mmHg)
- Endovascular obliteration (platinum spiral coils)
- NIMODIPINE - Ca2+ antagonist - decrease vasospasm
- NITROPRESSIDE - Tx HTN
