Intracranial haemorrhage can be spontaneous or brought on by a ___ ___.
What underlying pathology is usually responsible for subarachnoid haemorrhage?
What is a congenital problem which can cause subarachnoid haemorrhage?
The subarachnoid space is found between the ___ and the ___.
Which type of haemorrhage is relatively common and may be related to a Berry aneurysm?
Which circulation does a Berry aneurysm affect?
Circle of Willis
Where in the Circle of Willis do Berry aneurysms tend to form?
branch points between one artery and the next
What is the presentation of a subarachnoid haemorrhage?
Headache - sudden & severe; "worst headache of my life"; persistent
Vomiting - almost always
Neck pain - irritation of meninges in spinal cord subarachnoid space
Photophobia - ""
Subarachnoid haemorrhage and meningitis have similar presentations.
How do you tell the difference?
Subarachnoid haemorrhage presents with sudden onset headache
Meningitis headache has a gradual onset
Why do headaches seen in subarachnoid haemorrhage have a sudden onset?
Aneurysm collapses and SYSTOLIC BP transferred into parenchyma (i.e it occurs very quickly)
What type of meningitis is caused by subarachnoid haemorrhage?
Chemical meningitis - due to the blood
Which type of headache may mimic that of a subarachnoid haemorrhage?
How would you tell the difference?
What is benign coital cephalgia?
Sudden onset headache during / after sex
What are the clinical signs of subarachnoid haemorrhage?
Reduced conscious level
Focal neurological deficit e.g CN palsy
Which cranial nerve palsy is associated with brain aneurysms?
Which artery is implicated?
CN III palsy "down and out"
Posterior communicating artery
What is the first-line investigation for patients with subarachnoid haemorrhages?
Is a CT brain 100% specific for subarachnoid haemorrhage?
What colour is fresh blood on a CT scan?
What colour is CSF on a CT scan?
Where will blood be seen on a CT brain of someone with a subarachnoid haemorrhage?
i.e not in the ventricles
A CT brain is the first-line investigation for subarachnoid haemorrhage, but it may be negative.
What is the gold standard investigation?
What is seen in subarachnoid haemorrhage?
Bloody / "xanthochromic" CSF
What is xanthochromia in terms of a CSF sample?
Yellow-ish staining of CSF - blood breakdown products; indicative of subarachnoid haemorrhage
How do you tell the difference between bloodstained CSF (in subarachnoid haemorrhage) and a traumatic tap?
Take three samples
if amount of blood decreases with each tap, it's traumatic
Which imaging can be used to visualise blood vessels in cerebrovascular disease?
CT / MRI angiography
How long does bleeding actually last for in a subarachnoid haemorrhage?
< 1 second
because of compression, vasospasm etc. closing the bleed
Aneurysms which have burst are at major risk of ____ in the next two weeks.
fatal complication of subarachnoid haemorrhage
How is rebleeding prevented in patients with ruptured cerebral aneurysms?
feeding through a catheter and planting metal coils
Metal coils are implanted using a catheter to prevent ___ of ruptured aneurysms.
Apart from endovascular techniques, what else can be used to stop aneurysms from rebleeding?
What is a complication of subarachnoid haemorrhage which can occur 3 - 12 days following a bleed?