Subarachnoid hemorrhage

subarachnoid hemorrhage

Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates.

SAH pathophysiology

Most often arise at the bifurcation of the major arteries in the circle of Willis --aka Berry aneurysms -- 2% of the population has them

Conditions that predispose someone to SAH

- PCKD- HTN- Smoking- Ehlers-Danlos Syndrome- Neurofibromatosis Type 1

subarachnoid hemorrhage S/S

1. HA (often described as the worse HA of their life)2. LOC (about 40% will lose consciousness)3. N/V 4. Nuchal rigidity5. Fever6. Third cranial nerve palsy (mydriasis)

SAH Delayed neuro injury

1. reRupture (early coiling is the best intervention)2. Hydrocephalus (manifests as change in LOC)3. Delayed cerebral ischemia (aka Vasospasm can occur 2 days to 3 weeks)4. Hyponatremia (CSW)


- Non con head CT (95% accurate)- LP (CSF will be yellow)- Ottawa SAH scale

SAH management

1. Surgical coiling or clipping 2. Nimodipine for vasospasm prophy (60 mg q4hr)3. If patient becomes obtunded or decrease in LOC= EVD & Osmotic therapy4. Hyponatremia= Hypertonic saline

How fast can you correct Na+?

No more than 12 mEq/24 hours