Subarachnoid Hemorrhage

Question 1

What is the most common cause of blood in the subarchnoid space?

Answer 1

—Traumatic brain injury

Question 2

What is the most common cause of nontraumatic spontaneous subarachnoid hemorrhage (SAH)?

Answer 2

—Rupture of intracranial (saccular or berry) aneurysm

Question 3

How common are intracranial aneurysms in the US?

Answer 3

~1% of population

Question 4

_______ is the only risk factor that has consistently been identified with aneurysmal SAH

Answer 4

—Smoking

Question 5

—Other associated risk factors for aneurysmal SAH:

Answer 5

– Hypertension

– Heavy alcohol consumption

– Cocaine and amphetamine use

– Oral contraceptive use

Question 6

How does SAH present?

Answer 6

—Sudden onset of severe cataclysmic headache (approx 70% of patients)

N/V, neck discomfort, photophobia, and phonophobia (signs of meningeal irritation)

—Sudden loss of consciousness (up to approx 45% of patients) attributed to decrease in cerebral perfusion pressure (CPP) or malignant cardiac arrhythmias

Question 7

Question 8

What is the best imaging modality for SAH?

Answer 8

NCCT

Question 9

Answer 9

Question 10

Answer 10

Question 11

Answer 11

Question 12

What are some familial and hereditary factors associated with SAH?

Answer 12

— Polycystic kidney disease (autosomal dominant form)

— Marfan’s syndrome

— Ehlers–Danlos type IV

— Neurofibromatosis (type I)

— Pseudoxanthoma elasticum

— α-1-antitrypsin deficiency

— Sickle cell disease

Question 13

What is— Pseudoxanthoma elasticum?

Answer 13

Pseudoxanthoma elasticum (PXE), also known as Grönblad–Strandberg syndrome, is a genetic disease that causes fragmentation and mineralization of elastic fibers in some tissues.

The most common problems arise in the skin and eyes, and later in blood vessels in the form of premature atherosclerosis. PXE is caused by autosomal recessive mutations in the ABCC6 gene on the short arm of chromosome 16 (16p13.1)

Question 14

Question 15

Answer 15

Question 16

Answer 16

Question 17

Answer 17

Question 18

Answer 18

Question 19

Answer 19

Question 20

Answer 20

Question 21

Answer 21

Question 22

Answer 22

Question 23

Answer 23

Question 24

Answer 24