4.6 SAH

Question 1

Complications from SAH

Answer 1

1. ReBleed
2. Cerebral Vasospasm
3. Hydrocephalus
4. Cardioresp compromise / deterioration
5. Electrolyte disturbance
6. Other

Question 2

Prevention and management of complications related to SAH

Answer 2

1. ReBleed
2. Cerebral Vasospasm
3. Hydrocephalus
4. Cardioresp compromise / deterioration
5. Electrolyte disturbance
6. Other

Question 3

1. ReBleed

Answer 3

1. 15% probability D1

Rises to 40% 1st month

Mortality 50%

2. felt d/t BP fluctuations
3. Decision occlude aneurysm:
   age / comorbs / onset / anatomy / grading
4. Surgical clipping or endovascular coiling
5. Ai, to Rx ruptured <72hours

ISAT trial:
reduced complications coiling vs clipping
flaws - clipping ad lower rebleeds / higher success of occlusion

Question 4

2. Cerebral vasospasm

Answer 4

Most common cause mortality
CT Angio

Peak @D7
range D3-D14

Affects 3/4 SAH patients

Poor grade bleeds
large clots present in cisterns

Question 5

2. Cerebral vasospasm

Prophylaxis

Answer 5

Nimodipine PO/NG

Magnesium:
cerebral vasodilator
(reduces cerebral ischaemia)

Sedation
aim positive fluid balance
avoid hypotension / hypona

Question 6

2. Cerebral Vasospasm

Answer 6

Triple H

Hypertension
Norad

Hypervolaemia
Fluids

Haemodilution
Improve rheology

Other Rx
Primary balloon angioplasty
intra arterial papaverine

Question 7

3. Hydroephalus

Answer 7

.

Question 8

4. Cardiorespiratory

Answer 8

.

Question 9

5. Electrolyte disturbance

Answer 9

HypoNA
2nd CSW/ SIADH

Rx saline or hypertonic
steroids

Hypomagnesemia
hypoK
hypocalcaemia
Correct PRN

Question 10

6. Other

Answer 10

Hypothalamic dysfunction following ischaemia infarction

seizures