Subarachnoid Haemorrhage

Question 1

DDx of sudden onset headache

Answer 1

Migraine
SAH
benign coital cephalgia

Question 2

Presentation of SAH?

Answer 2

Sudden onset (thunderclap)
Collapse 
Vomiting 
Neck pain 
Photophobia

Question 3

CT scan in SAH?

Answer 3

May be negative if > 3 days post event

15% of patients have negative scan even if they have bled.

Question 4

Lumbar puncture in SAH?

Answer 4

Bloodstained or xanthochromic CSF (6-48hours)

Differentiate from traumatic tap

Question 5

Common focal neurological sign in SAH?

Answer 5

3rd nerve palsy

Question 6

What is gold standard for SAH?

Answer 6

Cerebral angiography

Used to assess vasculature and look for AVM/aneurysm

Question 7

Management of subarachnoid haemorrhage?

Answer 7

Maintain cerebral perfusion : IV saline (induce hypertension)

Give nimodipine (calcium channel blocker); reduces cerebral artery spasm and ischaemia

Refer to neurosurgery for aneurysm clipping or coiling.

Question 8

Hyponatraemia and SAH?

Answer 8

Develops due to release of salt wasting compounds from the cerebrum.

Management: sodium supplements, fludrocortison, do NOT fluid resist it.

Question 9

How can delayed ischaemic neurological deficit be prevented in SAH?

Answer 9

Give nimodipine.

Question 10

Management of subdural?

Answer 10

Burr Hole drilling or craniotomy

Question 11

Extradural management?

Answer 11

Clot evacuation and ligation of middle meninges like artery