Subarachnoid Haemorrhage

Question 1

What are the clinical features of a subarachnoid haemorrhage?

Answer 1

LOCATION : Posterior
PAIN : Sudden, like a bat to the back of the head, very intense
OTHER SYMPTOMS: Vomiting, neurological signs (LoC, confusion, photophobia, seizure, CN III palsy [rare] etc.), neck stiffness (rare)
DURATION : Varies

Question 2

What are the risk factors for a subarachnoid haemorrhage?

Answer 2

HTN, smoking, female, black ethnicity, FHx, ADPKD

Question 3

How do you treat an acute subarachnoid haemorrhage?

Answer 3

GENERAL : Cardiopulmonary support, surgical clipping/coiling, calcium channel blockers (vs. vasospasms), anticonvulsants, stool softeners (vs. straining)

HEADACHE : Analgesia (opioids e.g. fentanyl)

BMJ best practice also has some guidance if the patient has a cough, altered coagulation and hyponatraemia