Subarachnoid Haemorrhage

Question 1

What age group is particularly affected by subarachnoid haemorrhage?

Answer 1

40-60 years

Question 2

What are the predisposing factors for subarachnoid haemorrhage?

Answer 2

Smoking
Female
Hypertension
Positive family history
AD polycystic kidney disease
Ehlers Danlos syndrome
Coarctation of aorta

Question 3

Other than trauma and aneurysm, what are the possible causes of subarachnoid haemorrhage?

Answer 3

Arteriovenous malformation

Neoplasia

Question 4

What is the most common cause of spontaneous subarachnoid haemorrhage?

Answer 4

Aneursyms

Question 5

What is the most common cause of subarachnoid haemorrhage?

Answer 5

Trauma

Question 6

Describe the presentation of subarachnoid haemorrhage?

Answer 6

Sudden onset of headache (thunderclap headache)
Also possible:
Loss of consciousness
Seizures
Visual/speech/limb disturbance

Question 7

What findings may be present on clinical examination of a patient with subarachnoid haemorrhage?

Answer 7

Photophobia
Meningism
Subhyaloid haemorrhages
Vitreous haemorrhages
Speech and limb distrubance
Pulmonary oedema

Question 8

Describe the grading system for the severity of subarachnoid haemorrhage?

Answer 8

Grade 1. - GCS 15
Grade 2 - GCS 13-14 without deficit
Grade 3 - GCS 13-14 with deficit
Grade 4 - GCS 7-12
Grade 5 - GCS 3-6

Question 9

What is the first investigation which should be conducted when there is suspected subarachnoid haemorrhage?

Answer 9

CT

Question 10

What findings of subarachnoid haemorrhage would you expect to see in a lumbar puncture?

Answer 10

Xanthocromia (yellow CSF due to bilirubin)

Question 11

Describe the resuscitation of a patient with subarachnoid haemorrhage?

Answer 11

Bed rest
Fluids 2.5-3.0L normal slaine
Anti-embolic stockings
Nimodipine 60mg
Analgesia
Doppler studies

Question 12

What surgical interventions are used in the treatment of subarachnoid haemorrhage?

Answer 12

Surgical clipping

Endovascular (coils, stents, glue)

Question 13

When does rehaemorrhage most commonly occur in patients with subarachnoid haemorrhage?

Answer 13

Immediately after the initial bleed

Question 14

When does delayed ischaemic occur in patients with subarachnoid haemorrhage?

Answer 14

3-10 days after haemorrhage

Question 15

How is delayed ischaemia as a result of subarachnoid haemorrhage treated?

Answer 15

Fluid management - colloid infusions
Nimodipine
Inotropes
Angioplasty

Question 16

Once drugs and underlying conditions have been excluded, what are the most common causes of hyponatraemia in subarachnoid haemorrhage?

Answer 16

SIADH

Cerebral salt wasting

Question 17

How can hyponatraemia in subarachnoid haemorrhage be treated?

Answer 17

Hypertonic saline or fludrocortisone

Question 18

In subarachnoid haemorrhage there is sympathetic stimulation and catecholamine release. What complication can result from this?

Answer 18

MI

Question 19

Seizures often occur due to a re-rupture of an aneurysm in subarachnoid haemorrhage. T/F?

Answer 19

True

Question 20

Subarachnoid haemorrhage induces a prothrombotic state. Which condition can occur as a result of this?

Answer 20

DVT