Subarachnoid haemorrhage Flashcards
What is a subarachnoid haemorrhage
Subarachnoid haemorrhage is bleeding into the subarachniod space between the pia and arachnoid
Name some risk factors for subarachnoid haemorrhages
Trauma
Hypertension
Smoking
Cocaine use
Excess alcohol
Aneurysm
Family history
Why do the risk factors of subarachnoid haemorrhage increase the risk of one occuring
The risk factors increase the flow and pressure in the cerebral arteries which causes damage to the thin arterial walls, increasing the risk of aneurysms
These aneurysms can rupture and bleed into the subarachnoid space
Where are the most common locations of aneurysms that cause a subarachnoid haemorrhage
Anterior communicating artery - narrower than other cerebral arteries so have increased pressure in them when blood flows through
Basilar trunk - near to where posterior communicating arteries attach
Posterior communicating artery - cause painful CN III palsy due to location. Common for same reason as ACA - narrower lumen
Describe the presentation of a person with a subarachnoid haemorrhage
Explosive, severe thunderclap headache
DIffuse headache lasting 1hr to a wekk
Loss of consciousness
Confusion
Dizziness
Neck stiffness
Meningism
Focal neurology
How does the CSF from a lumbar puncture appear in a patient with a subarachnoid haemorrhage
Has increased opening pressure
Bloody/xantheochromic in colour
High in protein
Normal WCC
Normal glucose
High RBCs
What is xanthochromia and why you take multiple bottles of CSF if it appears bloody
Xanthochromia is where there is a yellow colour to the CSF
Occurs as RBCs are degraded in the CSF to Hb and then to bilirubin which appears yellow
Must take multiple bottles of CSF as it may appear red/yellow due to traumatic tap
Name some complications of subarachnoid haemorrhage
Death
Re-bleed
Cerebral ischaemia
Hydrocephalus
Seizure
Disability
What is the treatment of a subarachnoid haemorrhage
Decompression surgery
Coiling or clipping the aneurysm
Neurological observations
IV fluids
Nimodipine - CCB
