Subarachnoid Haemorrhage

Question 1

Subarachnoid Haemorrhage Epidemiology

Answer 1

Usually result of bleeding from a berry aneurysm

• Slightly more common in women
• Mean age 50
• Higher risk in Afro-Caribbean patients
• Spontaneous is mostly due to aneurysm, traumatic brain injury is more common cause of blood in subarachnoid space

Question 2

Subarachnoid Haemorrhage RFs

Answer 2

• Same as for stroke
• Hypertension
• Smoking
• Cocaine use
• Excessive alcohol intake
• Modifiable RFs account for two thirds

Question 3

Berry Aneurysms

Answer 3

• 4% prevalance

- 85% occur in circle of Willis

Question 4

Subarachnoid Haemorrhage Presentation

Answer 4

-Sudden explosive headache; may be only for a fraction of a second, like being hit on the head
-Headache not always severe
-Usually but not always accompanied by nausea and vomiting
-High index of clinical suspicion
-Seizures in 7%
-Acute confusional state in 2%
-Meningism may occur
-SAH should always be on differential list for patients with altered consciousness
Signs
-Depressed consciousness, neck stiffness, intraocular haemorrhages, isolated pupillary dilation, focal neurological signs (these signs do not always occur)

Question 5

Subarachnoid Haemorrhage Sentinel Bleeds

Answer 5

• Warning symptoms in three weeks prior to SAH that represent small leaks
• SAH-like headaches that resolve themselves

Question 6

Subarachnoid Haemorrhage Differentials

Answer 6

Stroke, meningitis, migraine, trauma,

Question 7

Subarachnoid Haemorrhage Ix

Answer 7

• CT as early as possible
• If CT negative and symptoms suggestive, LP
• Cerebral panangiography

Question 8

Subarachnoid Haemorrhage ECG Changes

Answer 8

-QT prolongation, Q waves, dysrhythmias, ST elevation

Question 9

Subarachnoid Haemorrhage Management

Answer 9

• Refer immediately to neurosurgery
• Re examine often and chart
• Nimodipine

Question 10

Subarachnoid Haemorrhage Complications

Answer 10

Rebleeding, cerebral ischaemia, hydrocephalus