Subarachnoid Hemorrhage – Morning Report 4/17/18

Etiologies

  • Trauma
  • Aneurysm (most common non-traumatic cause)
  • AVM
  • Arterial dissection
  • Cerebral venous thrombosis
  • Cocaine use
  • Anticoagulation
  • Reversible cerebral vasoconstriction syndrome

Clinical presentation

  • Thunderclap headache (worst headache of my life) = 97% of patients
  • Seizures = 10% of patients
  • Sudden death = 10-15% of patient
  • AMS (ranges from drowsiness to being obtunded) and nausea/vomiting due to elevated ICP

Diagnosis

  • CT non-contrast
    • Picks up 92% of SAH in the first 24 hours but the sensitivity is highest in the first 6-12 hours (drops to 60% by day 5)
  • If CT head is negative, do an LP
    • LP may be negative early on – best at about 12 hours
    • Look for elevated OP, RBCs that don’t clear (unlike traumatic tap), and/or xanthochromia

Treatment

  • If aneurysm – surgical clipping or endovascular coiling
  • Nimodipine to prevent vasospasm
  • BP control to goal < 140/80

 

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