Clip or coil once you
identify the aneurysm.
Hydrocephalus is a possibility.
And by this, you’re going to then drain
out the fluid, intraventricular catheter.
However, as soon as that happens, you’re
always worried about what, please?
Vasospasms, you want to treat that.
Highest rate within 21 days.
Treat with nimodipine,
Always look for or try to
manage your hypertension,
And here once again, you want to
try to control things and manage.
And so therefore
Oftentimes, you’ll find the
vasospasms within three weeks.
Continuing our discussion
of subarachnoid hemorrhage.
Let’s officially enter
the topic itself.
We just came off our
discussion of aneurysms.
And if that aneurysm is to then
get large enough, it ruptures.
And in this case, with the berry
aneurysm that we referred to,
you are then going to bleed
into your subarachnoid space
and perhaps even then bleed onto your
intraparenchymal type of hemorrhage.
The complications here as you know
would be the worst headache that
he or she has experienced
called “thunderclap headache.”
Meningismus type of symptoms,
and altered mental status.
On CT, you can then expect to see
the intraparenchymal type of
hemorrhage that you see here.
The complications that you’re worried
about as we had mentioned earlier,
if you peak approximately three weeks or
21 days into your subarachnoid hemorrhage,
you want to try to manage your vasospasms.
And there, we refer to our calcium
channel blocker, nimodipine,
or you are now also having issues with
properly draining your cerebrospinal fluid,
resulting in hydrocephalus
and that increase intracranial pressure
could be then managed with drainage,
maybe perhaps with
intraventricular type of catheter.
Risk factors: age, female,
gender, African-American race
most likely due to hypertension,
smoking, stimulants, alcohol.
Remember, if your patient you know is
predisposed to developing an aneurysm,
usually about let’s say
fifth decade of life.
Management of unruptured aneurysm,
1% of the general population.
Annual risk of SAH is 1 to 2%,
is related to aneurysm size.
Signs and symptoms. We
talked about the headache,
there could be loss of
consciousness, think of it as being
like a space-occupying lesion.
Differential diagnoses. At some point,
we have discussed cluster
headaches, migraines, meningitis,
are all differential diagnoses when
dealing with subarachnoid hemorrhage.
Acute and post acute
We did a lumbar puncture and we discussed
the tubes that you would find.
For example, because you’re continuously
introducing blood into the subarachnoid space
no matter how many samples
you take for RBC count,
It will always be pretty much
elevated between one and four.
Angiogram, you’d want to check out what
caused the subarachnoid hemorrhage
and transcranial Dopplers
as well could help you.
In other words, ultrasound.
The management here will be clipping.
We talked about coiling
of the aneurysm.
Treatment of the vasospasms
that we talked, nimodipine,
and we have our therapy of HHH,
hypertension, hypervolemia, hemodilution.
All so that you could manage
your subarachnoid hemorrhage.