Subarachnoid Haemorrhage

Question 1

What is it?

Answer 1

Bleeding in to the Subarachnoid Space

Question 2

What causes it? (4)

Answer 2

1. Berry Aneurysm rupture usually at the posterior communicating artery
2. Trauma
3. Arteriovenous Malformations
4. No cause in 15%

Question 3

Are they common?

Answer 3

Not really, affects 9 in 100,000 people per year, only 25% of thunderclap headaches in primary care are SAH

Question 4

Who does it affect?

Answer 4

More common in women (3:2), typical age of onset is 35-63 years old

Question 5

What are the risk factors? (7)

Answer 5

Smoking, alcohol misuse, hypertension, bleeding disorders, reduced oestrogen post menopause, pathology of the elastic lamina, connective tissue disorders

Question 6

Symptoms (9)

Answer 6

Sudden severe occipital headache, vomiting, collapse, seizures, coma, neck stiffness, dizziness, visual loss, dysphasia

Question 7

Signs (2)

Answer 7

Kernig’s Sign (can’t flex hip and straighten leg), retinal/subhyaloid and vitreous bleeds

Question 8

Are there any warning signs?

Answer 8

Yes, people can have small bleeds prior to a large one called ‘Sentinel’ Bleeds

Question 9

Differentials (4)

Answer 9

Meningitis, Migraine, Cluster headache, Tension headache

Question 10

Investigations (5)

Answer 10

CT, MRI, Lumbar Puncture (may show blood or xanthochromic), CT Angiography, ECG

Question 11

Treatment (8)

Answer 11

Refer to neurosurgery for endovascular Coiling (intracranial stents and ballooning is used), re-examine CNS every 15 mins, fluids to maintain cerebral perfusion, Nimodipine (Calcium channel blocker) to reduce vasospasm, Analgesia, Anti-emetic, May require ventilation, ventricular draining to prevent hydrocephalus

Question 12

Complications (4)

Answer 12

Death (50%), cerebral ischaemia, epilepsy, re-bleeding

Question 13

Is there a good prognosis?

Answer 13

46% have long term impairments that affect Quality of Life, 60% report frequent headaches, *long term prognosis depends on initial presentation