Subarachnoid haemorrhage Flashcards
Describe aneurysm formation in ASAH?
- Haemodynamic stress
- Inflammatory and immune reactions in unruptured aneurysms
What is pictured here?
Right temporal haematoma secondary to ruptured MCA aneurysm
What are the predisposing factors for an aneurysmal SAH?
- Smoking
- Female sex
- Hypertension
- Family history
- Coarctation of the aorta
Describe the presentation of ASAH?
- Seizures
- Sentinal headache
- Loss of consciousness
- Vision, speech, limb disturbances
Describe clinical signs that suggest ASAH?
- Photophobia
- Subhyaloid haemorrhages
- Vitreous haemorrhages (Terson’s syndrome)
What is the grading system used for SAH?
- Grade I = GCS 15
- Grade II = GCS 13-14 without deficit
- Grade III = GCS 13-14 with deficit
- Grade IV = GCS 7-12
- Grade V = GCS 3-6
Describe the use of a CT scan when investigating SAH?
- Confirms diagnosis
- Clues to cause
- Visualise complications (infarction, haematoma, hydrocephalus)
- Fisher grade prognosis
Name some other investigations in to SAH?
- Echo
- ECG changes
- Hyponatraemia
- Elevated troponin levels
Describe resuscitation following SAH?
- Saline
- Bed rest
- Analgesia
- Anti-embolic stockings
- Nimodipine via central line
Describe the management of ASAH?
- Surgical clipping
- Endovascular (coils, stents and glue)
- Conservative
What would be done for an Anterior Communicating Artery Aneurusm?
Fenestrated clips (clipping)
What can be done to counter aneurysm necks which are too large for a standard clip?
- Multiple clips
- Clips with longer blades
Name an endovascular treatment of a brain aneurysm?
Detachable coils
Name some complications associated with endovascular treatments of cerebral aneurysms
- Rehaemorrhage
- Pulmonary embolism
Describe Rehaemorrhage as a complciation of endovascular treatment of cerebral aneurysms?
- Incidence highest immediately following initial bleed
- Higher in poor grade patients and large aneurysms
- Immediate repair reduces rebleeding risk
Describe how you would treat hydrocephalus as a complication of cerebral aneurysm treatment)?
- Hourly external ventricular drainage
- Shunt
Describe delayed ischaemia post-cerebral ischaemia treatment?
- Day 3-10 after treatment
- Progressive deterioration with new deficit
How would you treat delayed ischaemia post-cerebral ischaemia treatment?
- Fluid management
- Colloid infusions
- Nimodipine
- Inotropes
- Angioplasty
What types of angioplasty can be used to treat delayed ischaemia?
- Balloon angioplasty
- Intra-arterial nimodipine
How would you treat hyponatraemia as a result of cerebral aneurysm treatment?
- Hypertonic saline
- Fludrocortisone
Name some cardiopulmonary complications which can result following treatment of a cerebral aneurysm?
- Sympathetic stimulation and catecholamine can injury heart
- Elevations of troponin
- Arrythmias
- Sudden death
- Myocardial function usually returns to normal within 3 days
Describe Seizures associated with ASAH?
- Some patients sufffer seizure after initial aneurysm rupture
- Can be a sign of re-rupture
Describe DVT prophylaxis with SAH?
- SAH induces prothrombotic state
- Sequential compression devices
- LMWH after aneurysm has been secured
