Sub arachnoid haemorrhage Flashcards

1
Q

What is a subarachnoid haemorrhage

A

bleeding between Arachnoid and Pia Mata

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2
Q

How would you describe the headache presented in SAH

A

Thunderclap or “blow to the back of head”

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3
Q

What are the risk factors for SAH

A
HTN
Aneurysm
Smoking
Alcohol
Polycistic kidney disease
Aortic coarctation
Ehlers and Marfans
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4
Q

What are the main risk factors for a berry aneurysm

A

Polycystic Kidney Disease
Aortic coarctation
Ehlers and Marfans

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5
Q

What can cause SAH

A

Berry aneurysm rupture (Circle of willis)
Arterovenous Malformation
-Tangled vessels
Idiopathic
Trauma to Anterior comms and ACA junction

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6
Q

What 5 ways can SAH occur

A
-Ischemia
-Raised ICP
-Lesion
-Blood irritating 
  meninges
-Vasospasm
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7
Q

Why can a lesion cause SAH

A

Pressure is applied on the brain

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8
Q

How can Vasospasm cause SAH

A

Bleeding irritate blood vessels causing Ischaemia

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9
Q

How can irritated meninges cause SAH

A

Blood irritates meninges
Meninges inflame and ause CSF obstrcution
Hydrocephalus occurs

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10
Q

What is Hydrocephalus

A

Fluid build up in the deep ventricles of the brain

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11
Q

What are the main symptoms of SAH

A

Thunderclap headache
Sentinel headache prior to Thunderclap
N+V
LOW Consciousness
CN3/6 Palsy

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12
Q

What are the signs of SAH

A
Stiff neck
Kerrig's sign
Brudzinski's sign
Retinal bleeds w/ pappiloedema
Focal neurological signs
HTN
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13
Q

What are focal neurological signs

A

paralysis
nerve palsy
tremors
lost muscle control

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14
Q

What is the Kerrig’s sign

A

Knee extension causes pain

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15
Q

What is the Brudzinki’s sign

A

Neck flexion = Knee flexion

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16
Q

What is the urgent investigation in SAH

A

Brain CT <24 HOURS

17
Q

What would a brain CT show

A

Star shaped with no ventricles

SAH = STAR

18
Q

What investigation would you do after 12 hours of SAH or if CT is negative

A

Lumbar puncture

-Only with normal ICP (no coning)

19
Q

What would a positive lumbar puncture show for subarachnoid haemorrhage

A

Xanthochromia (Red blood cell breakdown product)

CSF =Yellow (rbc waste)

20
Q

What other investigations could you do in SAH

A

MR/CT angiography

-imaging to find source of bleed)

21
Q

What are the surgical interventions in SAH

A
Endovascular coiling
Surgical clipping (If aneurysm present)
22
Q

How would you manage SAH

A

Urgent brain CT and referral
Lumbar puncture to check CSF
IV Fluid (for Cerebral perfusion)

23
Q

How would you manage Hydrocephalus in SAH

A

Ventricular drainage

24
Q

How would you manage SAH caused by Vasospasm

A

Nimodepine (Calcium antagonist)

  • 3 weeks
  • Decrease ischaemia = decrease vasospasm
25
Q

What scoring scale is used in coma assessment

A

Glasgow coma scale

26
Q

Describe the Glasgow Coma Scale

A

0-3 No response
3-8 Coma
8-15 Normal

27
Q

What are the main 2 differentials for Subarachnoid haemorrhage

A

Meningitis - Infection no thunderclap
MIgraine - No Meningism, No thunderclap