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Subarachnoid Haemorrhage

Subarachnoid Haemorrhage. Dr. Jonathan Yang Neurosurgery. SAH. Sudden onset of severe headache  SAH until proven otherwise !!! 5-10% of all non-traumatic intracranial haemorrhage 15/100000 population. Aetiology. Most common one for Adults  Rupture of a berry aneurysm 70%

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Subarachnoid Haemorrhage

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  1. Subarachnoid Haemorrhage Dr. Jonathan Yang Neurosurgery

  2. SAH • Sudden onset of severe headache  SAH until proven otherwise !!! • 5-10% of all non-traumatic intracranial haemorrhage • 15/100000 population

  3. Aetiology • Most common one for Adults  Rupture of a berry aneurysm 70% • Paeds  much less common, and most a/w AVM • AVM Adult 10% • Tumor, bleeding disorders, blood dyscrasia 5% • Idiopathic 15%

  4. Presenting features • Sudden onset of a severe headache not previously experienced by the patient. • Deterioration of conscious state • Meningism • Focal neurological signs • Intracerebral haemorrhage, local pressure effects, cerebral vasospasm

  5. Grades • Hunt and Hess grading system • 1 - 5 • WFNS grading system • 1 -5

  6. Investigations • CT • Best initial investigations • Confirm the dx in 85% • Provide A/W pathology • LP, Xanthochromia • Correct handling • Cerebral Angiography, CTA, DSA

  7. Cerebral Aneurysm • Most common cause of SAH in adult • Max in 4th and 5th decades of life • Arises at the branch points of two vessels • 85% anterior half of the circle of Willis • 15% posterior half of the circle of Willis • Multiple aneurysm occur in 15% of cases

  8. Pathogenesis • Saccular, berry or congenital aneurysm • Arises at the junction of vessels • Congenital deficiency in the muscle coat • Discontinuity of the underlying internal elastic membrane • Fusiform aneurysm • HTN

  9. Aneurysm (Related facts) • Seven fold in first degree relatives • 2-5% results in SAH (Lifetime) • Hereditary syndromes • Ehlers-Danlos Syndrome • Coarctation of the Aorta • Polycystic kidney disease

  10. Management of ruptured cerebral aneurysm • Three factors • Severity of the initial haemorrhage • 30% cases  death or deeply comatosed • Rebleeding of the aneurysm • Occurs in about 50% of patients within 6 weeks • 25% of patients within 2weeks of the initial haemorrhage. • Half of the patients die • Prevention VS Risks • Cerebral Vasospasm

  11. Cerebral vasospasm • Angiographic vasospasm occurs in about 50% of patients following SAH • 25% with serious outcome • Direct correlation between the amount of blood noted in the basal cisterns. • Does not usually occur until 2-3 days after the initial bleed. • And rarely delayed after 14days • Mx  Hypertensive, Hypervolaemia, Ca antagonist

  12. Mx of Aneurysm • Surgery • Occlusion of the neck • Reinforcement of the sac • Proximal ligation • Endovascular obliteration of the aneurysm • The access • Configuration

  13. AVM • Most common cause of SAH in children • Haemorrhage • Epilepsy • Progressive neurological deficit • Surgery • Size • Radiosurgical techniques • Less than 3cm

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