Subarachnoid haemorrhage

Question 1

Causes

Answer 1

Most common is traumatic

Intracranial aneurysm

AV malformation

Pituitary apoplexy

Arterial dissection

Mycotic (infective aneurysms)

Perimesencephalic

Question 2

Presenting features

Answer 2

Sudden onset, severe, occipital headache

Nausea and vomiting

Meningism

Coma

Seizures

Sudden death

Question 3

Confirmation of SAH

Answer 3

CT head
- hyperdense blood distributed in basal cisterns, sulci and ventricular system

LP
- used to confirm SAH if CT is negative
- 12 hours following onset of symptoms

Question 4

LP findings

Answer 4

Xanthochromia (12 hours after as thats the time needed for RBC breakdown)

Normal or raised opening pressure

Question 5

Treatment

Answer 5

Aneurysm- prompt intervention; coil; strict bed rest until then

Hydrocephalus- external ventricular drain

Question 6

Complications of aneurysmal SAH

Answer 6

Rebleeding (most common in first 12 hours)

Vasospasm (7-14 days after)

Hyponatraemia (due to SIADH)

Seizures

Hydrocephalus

Death

Question 7

Predictive factors in SAH

Answer 7

Conscious level on admission

Age

Amount of blood visible on CT head