SECRETS Neurology - Subarachnoid Hemorrhage & Hydrocephalus Flashcards
SAH sx
worst headache of your life
photophobia, meningeal irritation (stiff neck)
nausea, vomiting (increased ICP)
SAH association
berry aneurysms - polycystic kidney disease
SAH dx
CT
lumbar puncture at L3-L4 or L4-L5
L4 = iliac crest
SAH causes
ruptured berry aneurysm
ruptured AV malformation
head trauma
risk factors for berry aneurysm
hypertension
tobacco
family hx
CT disorders
berry aneurysms - location?
circle of Willis at junction of communicating arteries with main cerebral arteries
junctions lack internal elastic lamina and have attenuated tunica media
most common site is jxn with anterior cerebral artery and anterior communicating artery
complications of SAH
rebleeding
hydrocephalus
delayed ischemia due to vasospasm
hydrocephalus causes
1/3 = idiopathic 2/3 = following meningitis, SAH, intracranial surgery, head injury, intracranial tumor, congenital aqueductal stenosis
CSF production
active secretory process in choroid plexus of ventricles
pathway of CSF
lateral ventricles –> intraventricular foramen of Monro –> third ventricle –> cerebral aqueduct of Sylvius –> fourth ventricle –> lateral foramina of Luschka & medial foramen of Magendie –> subarachnoid space
CSF reabsorption
subarachnoid space –> arachnoid granulations –> superior sagittal sinus –> internal jugular vein
noncommunicating hydrocephalus
blockage between ventricles & subarachnoid space
blockage of cerebral aqueduct
enlarged lateral/third ventricles
normal fourth ventricle
headache, neuro dysfunction
communicating hydrocephalus
preserved communication between ventricles and subarachnoid space
due to either + production or - absorption*
bilateral papilledema, herniation
vision loss
hydrocephalus post SAH
fibrosis of arachnoid granulations from SAH & blood clotting
obstructive communicating hydrocephalus
