Which headaches are typically unilateral?
Red flags for headache?
What predisposes someone to cerebral aneurysms?
Connective tissue disorders
What is a sentinal headache?
A small haemorrhage causing a milder headache
Precursor to a more severe subarachnoid
What are some causes of sudden death?
Sudden cardiac death
Not to miss headaches?
Space occupying lesion
Giant cell arteritis
What causes focal neurological signs in subarachnoids?
Intracerebral component of bleeding
Local pressure of the aneurysms
What do you do if CT is clear when SAH is suspected? What would you find?
Blood breakdown products
- Xanthochromia (yellow CSF)
What pain management is safe for a patient with SAH?
Small IV doses of morphine
- Don't want to sedate as it will prevent the use of GCS to monitor patient
Why is it ok to LP someone with SAH hydrocephalus?
Because the pressures in the cranium and cord are the same
How does CSF get absorbed into venous system?
Via arachnoid granulations
Why does hydrocephalus occur in SAH?
Blood blocking the arachnoid granulations
Symptoms of raised ICP?
Nausea and vomiting
Headache - non-localised, morning headache
Changes in conscious state
Why do you get morning headaches with raised ICP?
Venous system is at the same level as the heart
Hypercapnia causes arterial vasodilation
How to reduce raised ICP?
Diuresis to reduce cerebral oedema (manittol)/extracellular fluid
Hyperventilation/avoid hypoventilation - can't do that too much
What are the symptoms of meningism?
Apart from aneurysms what are some other causes of SAH?
Spinal artheriovenous malformation
How are SAH Mx?
Avoid pain, straining, agitation, cough
Clip or coil
What is the Monro-Kellie doctrine?
ICP is directly related the contents of the cranium
What are the common sites for aneurysms to develop?
Bifurcation of internal carotid and Pcom (30-35%)
Bifurcation of MCA (20%)
Basillar bifurcation (5%)
Other posterior (5%)