Subarachnoid Haemorrhage Flashcards
(29 cards)
How common is subarachnoid haemorrhage?
- Accounts for 5% of all strokes
- Incidence 9/100,000/yr
What is the typical age of subarachnoid haemorrhage?
age 35-65
What are RF for subarachnoid haemorrhage?
- Hypertension
- Smoking
- FHx
- Autosomal dominant polycystic kidney disease (ADPKD)
- Age over 50
What is the most common cause of subarachnoid haemorrhage?
rupture of intracranial saccular aneurysm is leading cause of non-traumatic SAH (80% cases) – BERRY ANEURYSM RUPTURE
What are common sites of berry aneurysm?
- junctions of posterior communicating with internal carotid
- anterior communicating artery with anterior cerebral artery
- bifurcation of middle cerebral artery
What are the other causes of SAH?
- Arterio-venous malformations (AVM) (15%)
- Encephalitis
- Vasculitis
- Tumour
- Idiopathic
What are headache of SAH like and timings?
- Sudden severe headache
- Thunderclap headache
- Peaks in 1-5min and lasts more than 1hr
What are the associated features of SAH?
- Vomiting
- Photophobia
- Non-focal neurological signs
- Neck stiffness and muscles aches (meningisumus)
- Depressed consciousness/loss of
What are possible DDx for SAH?
- Non-aneurysmal peri mesencephalic SAH
- Arterial dissection
- Cerebral and cervical AVM
- Dual AVF
- Vasculitis
- Septic aneurysm etc
What tests do you do for SAH?
- Emergency non contrast CT head within 12hr
- If CT neg or inconclusive order LP
- Cerebral angiography to identity causal pathology
What would a non contrast CT head show in SAH?
hyperdense areas in the subarachnoid space/basal cisterns look for hyper-attentuation around circle of willis
When do you order a LP?
at least 12 hr after onset of symptoms
Why do you have to wait for LP?
12hr so allow breakdown of RBC so positive sample is xanthrochromic+oxyhaemoglobin (yellow due to bilirubin differentiated between old blood from SAH vs bloody tap
What bloods do you order for SAH?
- FBC: may show leukocytosis
- Serum Electrocytes: can show severe hypoatraemia
- Clotting profile: can show elevated INR, prolonged PTT
- Troponin I: may be elevated
- Serum glucose: may be elevated
- ECG: arrhythmias, prolonged QT, ST segment, or T wave abnormalities
What would the FBC show in SAH?
may show leukocytosis
What would serum electrolytes show in SAH?
can show severe hypoatraemia
What would clotting profile show in SAH?
- can show elevated INR
- prolonged PTT
What would troponin I and Serum glucose be like in SAH?
maybe elevated
What would ECG be like in SAH?
- arrhythmias
- prolonged QT
- ST segment
- T wave abnormalities
What the 1st line treatment if GCS <8 or falling?
stabilise and investigation same time - cardiopulmonary support
How else would you manage SAH with GCS <8 or falling?
- nimodipine as soon as diagnosis confirmed (prevent delayed cerebral ischaemia) – Ca2+ antagonist
- supportive care and monitoring
What is the 1st line trestment for SAH if the GCS>9?
supportive care and monitoring and nimodipine
What else would you consider for management of SAH with GCS>9?
- anticonvulsant
- Analgesia
- Stop and reverse anticoagulation
- Anti-emetic
- endovascular coiling or surgical clipping
- ventriculostomy or lumbar draining of CSF
What is the treatment of ongoing SAH with symptomatic vasospasm of SCI?
referral to neurosurgeon
