Subarachnoid Heamorrhage Flashcards
Aetiology and risk factors of Subarachnoid Heamorrhage
Bleeding into the space tends to be caused by ruptured saccular aneurysms (80%), venous malformations (15%) and unknown cause
Risk factors-Smoking, alcohol, high BP
Bleeding favored disorders, blood thinners
Post menopausal women
Close family had one- 5x chance to have one
Polycystic kidney disease. marfans, EDS
ususally between 35 and 65
signs and Sx of Subarachnoid Heamorrhage
Bleeding under the subarachnoid layer-into subarachnoid space-emergency
Caused by either aneurysm or venous malformations, and some aetiology not found
1/3 present ONLY had headache-with absolutely nothing else -THUNDERCLAP headache-extreme intensity, immediate onset, short
other: loss of consciousness, confusion/dizzy, vommiting, neck pain follow
dizzy/coma can last for days
can get diplopia
Abrupt, sudden, acute, thunderclap
very intense and quick “seconds to minutes”
PITFALLS-only headache, looking too well, getting better with NSAIDS
Neck pain (kernings signs),
Retinal bleeds
Focal neurological signs can suggest location of bleed (eg pupil changes would involve CIII)
Investigations of Subarachnoid Heamorrhage
CT scans done within hours of the incident is very present-see “whiter” areas in the sulci and stuff
4h within onset of Thunderclap headache is ideal
After a 1 day, the blood is broken down-not visible on scan
Lumbar puncture-to get the products of blood breakdown in the CSF-but only 12h after its started really
mild hypobnatremia
troponin can be raised w/o any heart disease
Management of SAH
Mainly A-E approach is crucial
contact neurosurgery
and maintain in meanwhile
if pt worsening- think acute bleed or hydrocephalus
seizures common
