Subarachnoid Haemorrhage Flashcards Preview

Neurology > Subarachnoid Haemorrhage > Flashcards

Flashcards in Subarachnoid Haemorrhage Deck (7)
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1
Q

EPIDEMIOLOGY

A
  • Incidence 6-20 per 100 000 per year
  • Rare <20y, most freq. btw 40-60y
  • 85% due to berry aneurysm
2
Q

CLINICAL FEATURES

A
  1. Sudden, severe headache
    - ‘hit by bat’
    - mostly generalised headache
  2. hypert.(50%)
  3. Neck stiffness(66%)
  4. Death before reaching hosp.(1 in 6)
  5. Focal signs(40%)
  6. vomiting
  7. transient LOC
  8. 3rd nerve palsy
    - PCA aneurysm. 3rd nerve palsies involving pupil are due to this till proven otherwise
    - uncal herniation
  9. 6th nerve palsy
    - false localising sign of hydrocephalus
  10. Opthalmoscopy –> subhyaloid haemorrhage
  11. Preceding sudden,severe headache(33%)
3
Q

DDX

A
  1. Thunderclap headache
    - X loss of consciousness, focal neurological signs
    - can be situational eg on exercise/sexual intercourse
    - after SAH ruled out
  2. Meningitis
    - headache, fever, neck stiffness, vomiting
  3. Coma
4
Q

INVESTIGATIONS:

  1. To confirm SAH
  2. To find source of bleed
A
  1. a) CT scan. 95% positive within 24h, 67% positive by 72h
    b) if CT negative, LP, delay till 12h(SIGN)
    - Xanthochromia, confirm w spectrophotometry.
  2. CT/MR angiography
5
Q

COMPLICATIONS

A
  1. Rebleeding from aneurysm(30%)
  2. Cerebral ischemia
  3. Obstructive hydrocephalus(from blood in ventricles)
    * Px with loss of consciousness/focal neurological signs.1-3 distinguished through repeat CT scanning

Occassionally:

  1. Hyponatraemia
  2. Arrythmias
  3. Neurogenic pulmonary oedema

Complications of bed rest:

  1. DVT
  2. aspiration pneumonia
  3. basal pneumonia
6
Q

MANAGEMENT

A
  1. Admit to ICU
  2. Frequently monitor neurological obs, GCS, BP, pulse
  3. Endovascular coiling/surgical clipping.
  4. CCB for vasospasm prophylaxis
    - nimlodipine 60 mg PO every 4h for 21d.
  5. Stool softeners to prev. straining.
  6. Adjuncts:
    a) antitussive for cough
    b) opioid analgesic for headache
    c) coagulopathy correction
    d) sodium replacement
    - rapid correction can precipitate central pontine myelinolysis
    - do not exceed correction rate of 12 mEq/24h
7
Q

ADDITIONAL

A
  1. Unruptured aneurysms
    - risk of bleeding=0.5% per year if >10 mm. 0.05% per year if smaller.
    - management option depends on life expectancy, operative risk and patient preference
  2. Giant aneurysm
    - Endovascular techniques best suited