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Subarachnoid Haemorrhage (Clinical Presentation (Brudzinski's sign…
Subarachnoid Haemorrhage
Key Facts
Spontaneous bleeding into the subarachnoid space - between the arachnoid layer of the meninges and the Pia mater
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Aetiology
Atriovenous malformation - vascular developmental malformation often with a fistula between atrial and venous systems
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Rupture of saccular aneurysms - at the junction of the posterior communicating artery with the internal carotid
Rare - bleeding disorder, mycotic aneurysms, acute bacterial meningitis, tumours
Risk Factors
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Disease that predisposes to aneurysm e.g. PKD, coarctation of aorta
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Smoking, bleeding disorders, post-menopausal decreased oestrogen
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Pathophysiology
Most common cause is ruptured aneurysm which leads to tissue ischaemia, as well as rapid raised Ice as the blood acts like a space-occupying lesion, puts pressure on the brain, resulting in deficits if not resolved quickly
Clinical Presentation
Brudzinski's sign (when patients neck is flexed by doctor, patient will flex their hips & knees)
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Vomiting, collapse, seizures and coma often follow
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Differential Diagnosis
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MUST be differentiated from MIGRAINE - the short time to maximal headache intensity and the presence of neck stiffness usually indicate SAH
Treatment
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Endovascular coiling - preferred to surgical clipping since has lower complication rate where possible
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Diagnosis
Head CT (gold standard) - seen as a 'star shaped lesion' due to blood filling in gyro patterns around the brain and ventricles
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Lumbar puncture
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CSF in SAH is uniformly bloody early on and becomes xanthochromic after several hours due to breakdown products of Hb
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