Subarchanoid haemorrhage

Question 1

What is it

Answer 1

an intracranial haemorrhage that is defined as the presence of blood within the subarachnoid space, i.e. deep to the subarachnoid layer of the meninges.

Question 2

common cause

Answer 2

trauma

Question 3

types of sah

Answer 3

traumatic

spontaneous

Question 4

causes of spontaneous SAH

Answer 4

Intracranial aneurysm

Arteriovenous malformation

Pituitary apoplexy

Arterial dissection

Mycotic (infective) aneurysms

Perimesencephalic (an idiopathic venous bleed)

Question 5

classic presenting features

Answer 5

thunderclap headache

N+V

Meningism

Coma

Seizures

Sudden death

ECG changes - ST elevation

Question 6

Ddx

Answer 6

clinical

CT

LP

neurosurgery referral

Question 7

Mx

Answer 7

Depends on cause

Intracranial aneurysms - coil interventional neruoradiologists but a minority require craniotomy and clipping by neurosurgeon

nimodipine 21 days - prevent vasospasm

external ventricular drain - hydrocephalus

Question 8

complications of sah

Answer 8

re-bleeding

vasospasms

hyponaetraemia

seizures

hydrocephalus

death

Question 9

predictive factors in SAH

Answer 9

conscious level on admission

age

amount of blood visible on CT head