Subarachnoid Haemorrhage

Question 1

What is a subarachnoid haemorrhage?

Answer 1

Intracranial haemorrhage defined as presence of blood within subarachnoid space

Question 2

What is the most common cause of a SAH?

Answer 2

*Head injury = traumatic subarachnoid haemorrage

Question 3

What are the causes of spontaneous subarachnoid haemorrage?

Answer 3

• Intracranial aneurysm (saccular ‘berry aneurysms) 85%
• Arteriovenous malformation
• arterial dissection

Question 4

What is the classical presenting features of a SAH?

Answer 4

*Headache
>Sudden onset
>Thuderclass 
>severe 10/10
>Occipital

• Nausea and vomiting
• Meningism: photophobia, neck stiffness
• Seizures
• Sudden death

Question 5

What ECG changes may be seen in SAH?

Answer 5

ST elevation

Question 6

What investigations will be done in suspected SAH?

Answer 6

1st: CT head
2nd: LP when CT negative (performed in 12hours following onset of symptoms)

Question 7

What is the management of a SAH as an FY1?

Answer 7

1. A-E assessment + GCS
2. CT head urgent
3. Referral to neurosurgery
   > CT intracranial angiogram to identify vascular lesion

Question 8

What is the treatment of a SAH by the neurosurgical team?

Answer 8

*Intracranial aneurysm treated with coil, minority require craniotomy and clipping