Subarachnoid Haemorrhage

Question 1

Biggest cause of a SAH?

Answer 1

Aneurysm rupture (80%)

Question 2

What other causes are there?

Answer 2

Arterioveous malformations (15%)

Question 3

Where are the commonest areas for a berry aneurysm to form?

Answer 3

Where the posterior communicating artery meets the ICA Anterior communicating artery meeting the ACA MCA bifurcation

Question 4

What is a SAH?

Answer 4

Bleeding into the subarachnoid space

Question 5

What do SAH’s typically present with?

Answer 5

Thunderclap headache

• Sudden “worst headache ever”

Vomiting

Collapse

Coma

Question 6

Signs of a SAH?

Answer 6

Neck stiffness

Kernig’s + after 6 hrs

Retinal haemorrhages

Focal neurological symptoms may indicate where aneurysm is

Question 7

What percentage of thunderclap headaches are SAH?

Answer 7

25%

Question 8

DDx?

Answer 8

Meningitis

Epidural/Subdural

Cerebral VT

Question 9

Tests?

Answer 9

CT HEAD

LP if safe

Prompt angiography in surgical candidates

Question 10

What are the LP findings?

Answer 10

Bloody CSF

• Detection of bilirubin is diagnostic

Question 11

Surgical management

Answer 11

IMMEDIATE -

• Low GCS
• Progressive focal deficit
• Cerebellar haematoma

Angioplasty for coiling and ballooning/stenting

Craniotomy for clipping

Question 12

Pharma management of SAH?

Answer 12

Control hypertension

• Carefully lower

Analgesia

Control vasospasm

Question 13

What drug can be used to control vasospasm?

Answer 13

Nimodipin

Question 14

What is the biggest cause of death in SAH?

Answer 14

Rebleeding