Subarachnoid Hemorrhage

Question 1

Incidence of SAH

Answer 1

6/100 000

Question 2

Mortality rate of aneurysmal SAH

Answer 2

30%

Question 3

Recurrence rate of SAH in survivors

Answer 3

40%

Question 4

Main cause of SAH

Answer 4

Saccular /berry aneurysm 85% from bifurcation of cerebral arteries

Question 5

Most common site of aneurysm in the circle of Willis leading to SAH

Answer 5

Anterior communicating artery 30% posterior communicating artery 25% middle cerebral artery 20%

Question 6

Risk factors of SAH

Answer 6

First-degree relative of those with saccular aneurysm
patients with polycystic kidney disease
Patients with congenital connective tissue defects Ehlers Danlos syndrome

Question 7

Management

Answer 7

Nimodipine in acute phase
Lower BP with thiazide diuretic, ACE inhibitor
Lifestyle changes
Platinum coils in aneurysm or surgical clipping

Question 8

Clinical features of SAH

Answer 8

Sudden severe throbbing headache often occipital for hours or even days
vomiting
raised blood pressure
neck stiffness or pain
worsening on exertion or sexual excitement
loss of consciousness on onset
Photophobia

Question 9

Investigation

Answer 9

Ct brain
Lumbar puncture after 12h of symptoms for xanthochromia
Cerebral angiography