Subarachnoid hemorrhage

Question 1

what is SAH?

Answer 1

subarachnoid hemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pial and arachnoid membranes . It occurs in various clinical contexts, the most common being head trauma. However, the familiar use of the term SAH refers to non traumatic (or spontaneous) hemorrhage, which usually occurs in the setting of a ruptured cerebral aneurysm or arteriovenous malformation (AVM).

Question 2

Risk factors of SAH?

Answer 2

Hypertension
Eclampsia
Oral contraceptive pill
substance abuse ( cigarette, alcohol, cocaine)
conditions associated with high incidence of aneurysms

Question 3

Cause of SAH?

Answer 3

*Trauma ( most commo
*Spontaneous SAH is due:
A) to rupture of cerebral aneurysm. 85%. They tend to be located in the circle of willis. 2 types of aneurysms:
1. Berry
2.saccular.

B) Idiopathic 15-20%
C) Arteriovenous malformation

*Other: coagulopathies, cocaine abuse, tumors

Question 4

symptoms of SAH ?

Answer 4

• Thunderclap headache is common , it may be accompanied by nausea and/or vomiting from increased ICP , seizures and meningeal irritation.
• Sudden loss of consciousness (LOC)
• Symptoms of meningeal irritation, including nuchal rigidity and pain, back pain, and bilateral leg pain, occur in as many as 80%.
• Photophobia and visual changes are common.
• Focal neurologic deficits : Cranial nerve palsy ( CN III, IV), hemparesis

Question 5

Diagnosis of SAH?

Answer 5

1. CT scan without contrast.
2. Lumbar puncture:
   Atleast 3 tubes should be collected.
   Elevated RBC is present equally in all bottles.
   Xanthochromia supernatant with centrifugation.
   Elevated protein due to blood breakdown products.
3. Four vessle cerebral angiography: Gold standars for aneurysms.
4. MRA & CTA.

Question 6

Treatment of SAH?

Answer 6

Stabilizing the patient : mechanical ventilation, Stabilize vital parameters
.
Medications:
Levetiracetam: seizure prophylaxis.
Nimodipine: for delayed cerebral ischemia neuroprotection. ( vasospasm)

Surgery:
*Clipping the ruptured aneurysm
*Coiling ( endovascular embolization)
choice between them depends on location of lesion and the neck of the aneurysm.