Subarachnoid Hemorrhage Flashcards
1
Q
What is the most common cause of SAH in people over 20? Under 20?
A
> 20 = aneurysm
< 20 = AVM
2
Q
What are the presenting signs of SAH?
A
- Sudden onset headache (WHOL)
- Diminished conscious state
- Meningism (neck stiffness, vomit, photophobia, fever)
- Focal neuro signs (intracerebral hemorrhage, pressure by aneurysm, vasospasm)
- Optic fundus changes
(retinal hemorrhage, papilloedema)
3
Q
What are the signs of an enlarging PCOMM aneurysm?
A
- 3rd nerve palsy
- (ptosis, pupil dilatation, extraocular muscle palsy)
- dilatation is key!
4
Q
What is on ddx for 3rd nerve palsy?
A
- diabetes retinopathy
- athersclerosis (stroke)
- if any doubt get angio!
5
Q
ACOMM aneurysm causes what?
A
- visual failure 2/2 to compression of optic nerve
6
Q
Patient presents with headache, physical exam with special attention to what?
A
- neck stiffness
- ams
- pupillary status
- fundal hemorrhage
7
Q
What are appropriate investigations for SAH?
A
- CT
- if CT negative, LP
8
Q
What is the difference berry anuerysms and fusiform aneurysms? Mycotic?
A
Berry = congenital Fusiform = intracranial hypertension Mycotic = septic emboli
9
Q
Which diseases have high prevalence of anuerysm?
A
- ethlers-danlos
- coarctation of aorta
- polycystic kidney disease
10
Q
How often does pt with SAH rebleed?
A
- 50% in 6 wks
- 25% in 2 wks
- 2-3% x year
11
Q
When does vasospasm usually occur?
A
- Within 2-3 days after initial SAH
- Rarely after 14 days
12
Q
Surgical procedures for aneurysm?
A
- occulsion of neck (clip)
- reinforcement of anerysmal sac (coil)
- proximal ligation of feeding vessel
13
Q
What are the clinical presentation signs of AVM in kids?
A
- Hemorrhage
- Epilepsy
- Headache
- Progressive neuro deficit
14
Q
What is the chance for hemorrhage from unruptured and ruptured AVMs?
A
- 3% x year
