Subarachnoid hemorrhage

Question 1

• subarachnoid haemorrhage*
• Define:*

Answer 1

is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain

Question 2

subarachnoid haemorrhage

Cause:

Answer 2

Brain Trauma, rupture of an aneurysm, (ICA)-internal Carotid artery, (MCA)-Middle cerebral artery, basilar a.

(berry – marfans, EDS, APCKD)

or

an Arteriovenous malformation (AVM)

Note: Berry aneurysms tend to appear at the base of the brain where the major blood vessels meet, also known as the Circle of Willis

Question 3

subarachnoid haemorrhage

symptoms:

Answer 3

“worst headache of my life”

• severe headache of rapid onset, vomiting, decreased level of consciousness, fever, and sometimes seizures.
• Neck stiffness or neck pain are also relatively common

Meningeal sign (+)

Question 4

Subarachnoid haemorrhage

Exams:

Answer 4

Exam – initially

– brain CT -> Spinal Tap (bloody or yellow)

= xanthochromic

-> angio CT

Question 5

subarachnoid haemorrhage

Treatment:

Answer 5

Surgery should be considered in every patient : depends on (1) patient’s general condition (2) time, within first 72 hours of after weeks to avoid vasospasm and secondary ischemia of brain)

Medication:

◆ cerebral edema : Mannitol, Furosemide, Glycerol

◆ prevention of angiospasm : CCB (Nimodipin), angioplasty

◆ For prevent re-rupture : control BP

Question 6

subarachnoid haemorrhage

Complications:

Answer 6

• Re-rupture
• Intracranial arterial vasospasm (Major complication, the only medication is Nimodipine)

-Hydrocephalus (accumulation of cerebrospinal fluid (CSF) occurs within the brain)