Subarachnoid haemorrhage

Question 1

what is a common cause of a subarachnoid haemorrhage

Answer 1

due to the rupture of an aneurysm
most common around the circle of Willis

Question 2

what are the risk factors for a SAH

Answer 2

hypertension
smoking
family history of aneurysmal SAH
connective tissue disorders

Question 3

what are the clinical features of SAH

Answer 3

typically presents with a thunderclap headache (10/10 pain, sudden onset)
may present with reduced consciousness, seizures, focal neurological signs, meningism)
sudden or rapid death may occur
some arise after exertion, but most arise spontaneously

Question 4

how are SAH diagnosed

Answer 4

most are visible on brain CT
ability to detect (sensitivity) decreases after 12 hours
if appropriate history for SAH but no bleeding on CT then a lumbar puncture is performed
LP is to test for evidence of bleeding into CSF space (xanthochromia), need to do this 12hrs after onset to allow for blood breakdown products
if xanthochromia is detected, angiography (CT,MRI or invasive) to look for culprit lesion

Question 5

what is the management of a SAH

Answer 5

supportive care - basic resuscitation measures, management of complications
nimodipine - prevents the development of delayed cerebral ischaemia by preventing arterial vasospasm
secure aneurysm - typically coiling via an endovascular procedure or clipping (neurosurgical)
ongoing rehabilitation and long-term care (including psychological support)