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Subarachnoid hemorrhage - Coggle Diagram
Subarachnoid hemorrhage
Mcc, berry aneurysm
Mc site is anterior communicating artery
Cf: tunnel vision
Av malformation
Associated with
adult type polycystic kidney disease
Connective tissue diseas
Marfan.AD febrinin defect
Long arms
Lower segment is longer than the upper segment
Mitral valve prolapse
Aortic regurgitation
Prone to aortic dissection
Arachnodactylyاصابعين طويلة زي العنكبوت
Ddx is homocysteinurea same features but marfan have upward lense dislocation ectopia lintes, homo ,downward dislocation
Homo , mentally retarded
Ehlers danlos
Coarctation of the aorta
Second mc site of berry aneurysm is
Post. Communicating artery.
It cause oculomotor nerve palsy Before it ruptures
Presentation
Ptosis (levator palpepri superioris )
Eye downward and outward (only muscles working lateral rectus and superior oblique)
Pupils
Dilated
3rd erve barrow parasympathetic fibers from edinger westfal nucleus, these fibers are lateral to the nerve, so lat.compression causes dilated pupils as the case in post.com aneurysm
Not dilated
If, ischemia esp in dm- damage spares lat.fibers. pupil not dilated
Clinical features
Worst headache ever,.thunder clap headache occipital
Meningism (neck stiffness, Kernig's and Brudzinski)
Is found also in
Meningitis and pituitary apoplexy(sudden hge in pit galnd in a tumor result in loss of all pit hormones)
In sub arach. Hypertension (ischemia reflex inc in bp)
In pit apop , hypotension no cortisone and no aldosterone
Dx
CT:blood in Csf if negative and still suspect subarach do lP. After 12hours looking for xanthochromia degredation of hg produce bilirubin, yellow color
Treatment: nimodipine to prevent ischemia and refer for neurosurgical unite
Hemoclliping or coiling
Complications
Mcc of mortality is re bleeding
Mcc of morbidity is vasospasm ischemia
Hydrocephalus, communicating type, blood clots closes some areas
SIDAH, cf: hyponatremia
In meningitis, encephalitis, brain hge, tumors
In,PE, pneumonia, asthma, fibrosis