Subarachnoid Hemorrhage :-
Pathologic Condition where blood enters the subarachnoid space. √ Causes :- Rupture Of Aneurysms At Circle Of Willis ( 80 % ) Other Causes :- ( MIA BATS ) B - Bleeding Diathesis / Berry Aneurysm A - Arteriovenous Malformations / Adult Polycystic Kidney Disease ( AKPD ) T - Trauma S - Stroke ( 10 % ) M - Mycotic Aneurysms I - Intracerebral Bleed Extensions A - Anticoagulant Therapy Risk Factors - Alcohol, Smoking, Hypertension And Sympathomimetic Drugs ( Cocaine And Phenylpropanolamine ) And Certain Genetic Syndromes ( APKD And Type 4 Ehlers-Danlos Syndrome ) √ Clinical Features :- • Headache ( Abrupt And Severe ) + With Or W/O Vomiting. ONSET ( May Show Rise In BP, Lost Consciousness And Seizure ) . • Sentinel Headaches ( Milder Warning Headaches ) - 2-8 Wks Preceding The Major Headache. • Headache ( Maybe A/S With S/S Like Nausea, Vomiting, Neck Stiffness, Loss Of Consciousness Or Focal Neurological Deficits ) . • Seizures - After SAH ( Mostly in first 24 Hrs ) Or In SAH A/S With Intracerebral Hemorrhage, Hypertension And Middle Cerebral And Anterior Communicating Artery Aneurysms. • Examination - Signs Of Meningeal Irritation ( Written In Last Post ) , Focal Neurological Deficts ( Bleeding In Adjacent Brain Parenchyma ) , Subhyloid Hemorrhage ( Fundoscopy, Occasionally ) . • Posterior Communicating Artery And Third Cranial Nerve Palsy - Observed. √ Investigations :- • CT-Scan > Lumbar Puncture • CT-Angiography ( Larger Aneurysms ) > MR-Angiography ( Aneurysms > 5 mm In Size ) • Angiography ( In Patients Fit For Surgery - Age < 65 Yrs And Not In Coma ) - Locate Site Of Aneurysm Which Has Bled. • Spectrometry - To examine CSF to check bilirubin. √ Treatment :- • Absolute Bed Rest ( 4 Wks ) With Gradual Resumption Of Physical Activities , Airway, Pain And Hypertension Treatment, ICT Management ( Labetalol, Esmolol Or Nicardipin Used, Sodium Nitroprusside Avoided ) , Sedate The Patient, Strict Avoidance Of Hypovolemia, Hypotension, Hypothermia, Hypoglycemia And Hyponatremia ( Delays Cerebral Ischemia ) . • Aneurysms - Clipping Of Aneurysm, Endovascular Coiling To Ablate Aneurysms, Prevention And Management Of Neurological Complications Due To Aneurysm Bleeding ( Antifibrinolytic Agent - Tranexamic Acid 1 g IV followed by 1 g every 6 hrs ) . • Calcium Blocking Agents ( Nimodipine - 60 mg/4 Hrs Orally ) - Reduces Cerebral Arterial Vasospasm.
