Subarachnoid haemorrhage

Question 1

features of SAH on head CT ?

Answer 1

hyperdensity (appears white on CT due to iron in blood)

typically distributed in the basal cisterns, sulci and in severe cases the ventricular system

Question 2

features of SAH in LP ?

Answer 2

xanthochromia

increased / normal opening pressure

Question 3

describe how to confirm suspected SAH ?

Answer 3

urgent head CT
- hyperdensity

if CT negative then LP
- LP has to be done at least 12 hours after onset of SAH to allow development of xanthochromia

referral to neurosurgery if confirmed SAH

Question 4

how is vasospasm prevented in a patient with SAH ?

Answer 4

21 day course of nimodipine (CCB)

Question 5

how would you treat vasospasm ?

Answer 5

vasodilating agents e.g. verapamil
hypervolaemia
induce hypertension
haemodilution

Question 6

complications of aneurysmal SAH ?

Answer 6

vasospasm (commonly within 7 - 14 days after onset) 
re-bleed (commonly in first 12 hours)
hyponatraemia (SIADH)
seizures
hydrocephalus 
coma 
death

Question 7

predictive factors in SAH ?

Answer 7

age
conscious level at admission
amount of bleed visible on CT head