Subarachnoid haemorrhage

Question 1

Aetiology?

Answer 1

85% - rupture of a saccular aneurysm at the base of the brain (Berry aneurysms)

10% - perimesencephalic haemorrhage

5% - arteriovenous malformations, bleeding diathesis, vertebral artery dissection, anticoagulant use

Question 2

Risk factors?

Answer 2

Hypertension
Smoking
Excess alcohol intake (associated with stroke’s too)

Saccular aneurysms are associated with:
Polycystic kidney disease
Marfan’s syndrome
Ehlers-Danlos syndrome

Question 3

Presenting symptoms?

Answer 3

Sudden-onset worst headache ever

Nausea/vomiting

Neck stiffness

Photophobia

Reduced level of consciousness

Question 4

Signs?

Answer 4

Meningism

Neck stiffness

Kernig’s sign - also in meningitis

Pyrexia

GCS - check for deterioration

Signs of raised ICP - papilloedema, IV or III nerve palsies, hypertension, bradycardia

Question 5

ivx?

Answer 5

1. CT head - diagnostic - hyperdense areas
2. FBC - leukocytosis
3. Coagultion elevated INR, prolonged PTT
4. Lumbar puncture - XANTHOCHROMIA (only positive after 12 hours)

others
Ecg - abnormal - arrhythmia etc
tropinin 1 - elevated

Question 6

which artery is implicated in subarachoid haemorrhage

Answer 6

branches of the circe of willis

ACA, MCA, internal carotid usually

Question 7

mx?

Answer 7

see y6 pwp