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Flashcards in [SAH] Deck (48)
1

[SAH]: 80% of SAH caused by

rupture of saccular (aka berry) aneurysm

2

[SAH]: cause of saccular aneurysm in majority is ..

hereditary weakness in blood vessels (esp. circle of willis)

3

[SAH]: Which 2 junctions are most frequently affected by saccular aneurysms

ant. comm. / ant. cerebral

Post. comm. / internal carotid

4

[SAH]: 5% SAH have no found cause, another 15% caused by?

AV malformations

5

[SAH]: relatives are at ... x increased risk

3

6

[SAH]: Smoking, alcohol and ^BP are risk factors with mycotic aneurysms. What is a mycotic aneurysm ?

Aneurysm due to bacterial infection of the vessel wall.

7

[SAH]: SAH associations

Polycystic kidney
Coarctation of aorta
Ehlers-Danlos (collagen, hypermobile)

8

[SAH]: Typical presentation?

Within seconds
worst ever headache
occipital typically

9

[SAH]: Apart from headache what symptoms may occur (3)

Seizures/collapse
coma (can last days/drowsiness for days)
vomiting

10

[SAH]: What signs may there be

Neck stiffness

11

[SAH]: Describe Kernig's sign

Hip and knee flexed 90
extension in the knee is painful (resistance)

12

[SAH]: what is a + kernigs sign indicative of (2)

SAH
Meningitis

13

[SAH]: 15% caused by ... (2nd most common cause)

AV malformations

14

[SAH]: What is a mycotic aneurysm ?

Aneurysm due to bacterial infection of the vessel wall.

15

[SAH]: How is it normally described?

worst ever headache

16

[SAH]: patients can be in a coma/drowsy for how long?

days

17

[SAH]: what is a + kernigs sign indicative of (2)

SAH
Meningitis

18

[SAH]: Where is the headache often localised to

occipital

19

[SAH]: over what timecourse does the the headache occur usually

seconds

20

[SAH]: what often occurs after the headache?

Seizure --> coma

21

[SAH]: SAH associations (3)

Polycystic kidney
Coarctation of aorta
Ehlers-Danlos (collagen, hypermobile)

22

[SAH]: What sign

Neck stiffness

23

[SAH]: seizure and coma occur when in relation to the headache

after

24

[SAH]: Why would fundoscopy be relevant

vitreous/retinal bleeds - sign of SAH

25

[SAH]: what is a sentinel headache

Prior warning headache (rare)(small leak)

26

[SAH]: 1st line investigation?

CT

(within 48hrs!)

27

[SAH]: if 1st line investigation -ve what 2nd line Ix is done

LP

28

[SAH]: How long after SAH do you have to wait before perfoming an LP

>12hrs

29

[SAH]: In LP what would be found

xanthochromia (yellow - bilirubin)

*only red in the acute early phase OR a bloody tap*

30

[SAH]: Mx: how soon should patients be referred to neurosurgeons

immediately

31

[SAH]: Mx: what systolic BP should you aim for?

>160mmHg

32

[SAH]: Mx: Why do you aim to keep the BP high?

maintain cerebral perfusion

33

[SAH]: Mx: what drug is given is reduce vasospasm?

Nimodipine (60mg/4hrs

34

[SAH]: Mx: what is nimodipine?

Ca2+ antagonist - reduced vasospasm

35

[SAH]: Mx: what is the 1st line surgical treatment

Endovascular coiling

36

[SAH]: Mx: what investigation MUST you do in an already proven SAH case before surgically intervening

catheter/CT angiography

37

[SAH]: Mx: why must you do further imaging in an already proven case of SAH

to identify single or multiple aneurysms

38

[SAH]: what is the commonest complication causing death post treatment

rebleeding

39

[SAH]: what is the complication associated with vasospasm

Cerebral ischaemia causing permanent CNS deficits

40

[SAH]: what is the complication associated with vasospasm

Cerebral ischaemia causing permanent CNS deficits

41

[SAH]: what is the commonest cause of mortality

rebleeding

42

[SAH]: what is them commonest cause of morbidity

cerebral ischaemia

43

[SAH]: What sign is

Neck stiffness

44

[SAH]: what is them commonest cause of morbidity

cerebral ischaemia

45

[SAH]: is SAH associated with neck stiffness

Yes

46

[SAH]: is SAH associated with neck stiffness

Yes

47

[SAH]: Hydrocephalus is a recognised complication, what causes this

blockage of arachnoid granulations

48

[SAH]: how is hydrocephalus treated

ventricular/lumbar drain