Subarachnoid Haemorrhage Flashcards Preview

Tim CP3 @ UoN - Medicine & Surgery > Subarachnoid Haemorrhage > Flashcards

Flashcards in Subarachnoid Haemorrhage Deck (15)
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1
Q

How common are Sub-Arachnoid Haemorrhages?

A

5% of strokes

2
Q

What are the common sx of a SAH?

A

Thunderclap headache (+/- sentinel headache)
Vomiting (post headache)
Photophobia
Increasing drowsiness/coma
Focal signs (raised ICP, cerebral vasospasm, locate lesion)

3
Q

What are the common signs of a SAH?

A

Neck stiffness
Kernig’s +ve (6hrs to develop)
Papilloedema (+/- retinal haemorrhages)

4
Q

What are the characteristics of a thunderclap headache?

A

Develops over seconds
Devastating in intensity
Often occipital
Often comes on during transient HTN (exercise/sex)

5
Q

What is a sentinel headache?

A

Smaller headache due to warning leak from aneurysm

6
Q

What are the common predisposing abnormalities to SAH?

A
Berry aneurysm (70%)
AV malformations (10%)
No lesion (20%)
7
Q

What is a Berry Aneurysm?

A

Developmental aneurysm in circle of Willis/adjacent arteries

8
Q

Where do Berry Aneurysms commonly form?

A

Anterior communicating artery (most common)
Posterior communicating artery (bifurcation from ICA)
Middle cerebral artery (at bifurcation/trifurcation)

9
Q

What are the risk factors for Berry Aneurysms?

A
Polycystic Kidney Disease
FH
Smoking
HTN
Ehlers-Danlos/Marfans
10
Q

What is a common mass effect of Berry Aneurysms?

A

Painful 3rd nerve palsy

11
Q

What is an arteriovenous malformation?

A

Congenital collection of abnormal arteries/veins
Tendency to rebleed (10%)
Can cause epilepsy (focal)

12
Q

What are the potential complications of a SAH?

A
Death (30%)
Rebleed
   -aneurysms after 3-4/7
   -avm after years
Hydrocephalus (fibrosis in CSF pathways)
Cerebral vasospasm (delayed ischaemic damage)
13
Q

What are the appropriate investigations in a suspected SAH?

A

Bloods - FBC, U&Es, LFT, ESR, clotting
CT - blood seen w/i 48hrs, quantity = prognosis, AVM visible on CT
LP - if CT normal, >12hr after sx onset, CSF will be xanthochromic
CT/MRI angiography - determines underlying vascular anatomy

14
Q

What is the appropriate management of suspected SAH?

A
4wks bed rest
HTN control
Nimodipine (prevents vasospasm, reduces mortality)
IV fluids
Analgesia, anti-emetics
Stool-softeners
15
Q

What is the neurosurgical management of suspected SAH?

A

Coiled by interventional radiology

Gamma knife therapy

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