Subarachnoid Hemorrhage Flashcards
What is the outcome of patients suffering from aneurysmal SAH?
10% DBA
1/3 die
1/3 poor outcome
1/3 good outcome
What is the risk of rebleeding of SAH in case aneurysm is not secured?
D1 - 4-14% (死實死) D2-13 - 1.5%/day First 2 weeks - 20% First 1/2 year - 1/2 Then 3% every year
What is the natural history of vasospasm?
Almost never before D3
Peak D6-8
Till D14
Rare after D17
How many patients have clinical and radiological vasospasm?
30%
50%
What are the etiologies of SAH?
- Trauma (commonest)
- Spontaneous
- aneurysm
- dissection
- AVM
- vasculitis, RCVS
- spinal AVM
- pituitary apoplexy - Idiopathic (20%)
What are the dDx of LOC in SAH?
- ICP
- HCP
- ICH
- Seizure
- Shock
What is the natural history of vasospasm?
Almost never before D3
Peak D6-8
Till D14
Rare after D17
How many patients have clinical and radiological vasospasm?
30%
50%
What are the types of ocular hemorrhage happened in SAH?
- Retinal
- Preretinal
- Vitreous (Terson syndrome)
What are the features and implication of Terson syndrome
- due to local pressure, CRVO, venous HT and hemorrhage
- usually bilateral, usually secondary to ruptured ACoA
- can be delayed
- can resolve spontaneously
- associated with higher mortality
What are the risk factors of aneurysm rupture?
Modifiable:
- HT
- Smoking
- Drinking
- Sympathomimetics
Non-modifiable: 1. Gender and race 1. Female 2. Japan and Finland 3. Race: African American, Hispanics 2. History 1. Personal Hx of SAH 2. FHx of SAH 3. FHx of aneurysm 3. Aneurysm 1. >7mm 2. Posterior circulation 3. Symptomatic (impending rupture/ruptured) 4 Genetics 1. PKD 2. Type IV Ehlers-Danlos
What is the classical angiographic appearance of reversible cerebral vasoconstrictive syndrome?
String and bead appearance
What are the precipitating drugs for RCVS?
- illicit: cocaine, marijuana
- antidepressants: ergot, SSRI
- nasal decongestant, nicotine patch
What are the definitions of aneurysm and infundibulum?
Aneurysm - arterial dilatation of more than 50% of its vessel diameter
Infundibulum - funnel shape initial segment of artery (usually PCoA)
- Mouth <3mm
- Triangular shape (Outflow angle <90)
- Vessel at apex
What are the factors to decide which aneurysm ruptures in case of SAH with multiple aneurysms?
- Clinical
- third nerve palsy (PCoA) - NCCT
- location of sentinel clot
- Sylvian fissure (MCA, PCoA)
- interhemispheric fissure (ACoA)
- IVH (ACoA, BA, PICA/VA) - Angiogram
- daughter sac
- larger aneurysm
- focal vasospasm
