Subarachnoid haemorrhage Flashcards
1
Q
Where is a a subarachnoid haemorrhage found?
A
between arachnoid and Pia mater
2
Q
Typical age on onset of SAH?
A
35-65
3
Q
What are the causes of SAH?
A
- rupture of saccular (berry) aneurysms ~80%
- AV malformations ~ 15%
- no cause found in <15%
4
Q
What are the risk factors SAH?
A
- smoking
- alcohol misuse
- HTN
- bleeding disorders
- mycotic aneurysm
- close relatives have 3-5 fold risk
5
Q
Where are the common sites for berry aneurysms?
A
- junction of posterior communicating with internal carotid
- anterior communicating with ACA
- bifurcation at MCA
6
Q
What are berry aneurysms associated with?
A
- polycystic kidneys
* coarctation of the aorta
7
Q
What are clinical features of SAH?
A
- sudden onset with severe, devastating occipital headache
- vomiting
- seizures
- collapse
- coma and drowsiness can last for days
- neck stiffness
- kernig’s sign
- retinal, subhyaloid and vitreous bleeds
- focal neurology at presentation suggests the site of the bleed
8
Q
What investigations are done for SAH?
A
•CT - detects 90% in first 48 hours
* LP if CT -ve
9
Q
management SAH?
A
- keep hydrated
- nimedopine (Ca2+ antagonist),decreases vasospasm ad consequent morbidity
- end-vascular coiling to stop bleeding and fix aneurysm
10
Q
What is the commonest cause of death in SAH?
A
Rebleeding
