Subarachnoid hemorrgae

Question 1

What is it?

Answer 1

Bleeding into the SA space (contains the CSF)

SA is between Pia and arachnoid

Question 2

Aetiology

Answer 2

Cerebral ruptured aneurysm

Trauma

Question 3

Presentation

Answer 3

Thunderclap headache

Sudden onset 
Occipital 
Usually during strenuous activity 
Neck stiffness 
Photophobia 
Weakness, seizure, speech

Question 4

Risk factors

Answer 4

HBP
Smoking 
alcohol 
cocaine 
FH 
Black 
Female 
45-70

Question 5

REALLY IMPORTANT RISK FACTORS

Answer 5

Use of cocaine
Sickle cell anaemia
CT disorders e.g. marfans
Neurofibromatosis

Question 6

Investigations

Answer 6

CT head - may be normal or Hyperattenuation
LP: test CSF

Angiography: CT or MRI

Question 7

Management

Answer 7

• Intubation and Ventilation
• Nimodopine- CCB- Vasospasm preventer- can lead to brain ischaemia following aneurysm
• Surgical intervention to repair the aneurysm
• Shunt used to reduce pressure
• Anti-epileptics to treat seizures

Question 8

Surgical intervention

Answer 8

Coiling

• catheter into arterial system
• platinum coils which block off the aneurysm

Clipping
- put a clip on the aneurysm of the aneurysm to seal it

Question 9

What do you see on CSF

Answer 9

(RCC raised)

Xanthocromia- yellow colour to blood- bilirubin

Question 10

Complications

Answer 10

Vasospasm

Rebleed

Question 11

Which brain bleed looks like eclipse?

Answer 11

Epidural

Question 12

Which brain bleed is crescent shaped?

Answer 12

Subdural

Question 13

Risk factors for brain bleeds

Answer 13

Head injury 
HBP 
Aneurysms 
Ischaemic stroke 
Brain tumours 
Anticoagulants- warfarin

Question 14

Presentation of brain bleeds?

Answer 14

Seizures
focal weakness
vomiting
loss of consciousness

Question 15

When do you need to worry about airway maintenance?

Answer 15

Less than 8 out 15 need to make sure you can maintain their airways

Question 16

Eye movement

Answer 16

Spontaneous
In response to speech
In response to pain
No movement

Question 17

Verbal response

Answer 17

Orientated 
Confused 
Inappropriate words
Incomprehensible sounds 
No verbal response

Question 18

Motor response

Answer 18

Obey commands 
Localise pain 
Normal flexion 
Abnormal flexion 
Extension of limbs 
No movement

Question 19

Who gets subdurals?

Answer 19

More commonly in elderly patients and alcoholics as they have more atrophy in their brains

Question 20

Extradural/ Epidural hemorrage aetiology

Answer 20

Middle meningeal artery in the temporal-parietal region
Between the skull and the dura mater

Have a bi-convex shape
Does not cross over the sutures

Question 21

Extradural/ Epidural hemorrage aetiology

Answer 21

Middle meningeal artery rupture at the pterion.
It is found between the skull and the dura mater

Have a bi-convex shape
Does not cross over the sutures

Question 22

Management of brain bleed

Answer 22

Immediate CT head 
FBC
Clotting profile 
Specialist stroke centre
Intubation, ventilation, ICU 
Assess with neurosurgeon whether they would do surgery

Question 23

when is LP contraindicated!

Answer 23

Extradural

Question 24

Intracerebral hemorragia

Answer 24

Bleed into the cerebral tissue