Neuro: Subarachnoid Haematoma: Free MSRA Podcast

🎧 FREE MSRA PODCAST – Subarachnoid Haemorrhage (SAH): When Every Second CountsDive into one of the most dramatic and high-stakes emergencies in medicine: SAH. We break down what you need to spot, what you must do, and the key pitfalls for the MSRA — and real-life practice.📝 Key Learning Points📌 Definition• SAH = sudden bleeding into the subarachnoid space (between the arachnoid and pia mater) around the brain.• Most often due to a ruptured intracranial aneurysm.• Can also result from trauma or an AVM (arteriovenous malformation).📌 Causes & Risk Factors• Ruptured cerebral aneurysm (≈85% of spontaneous SAH)• AVM, trauma, vasculitis, brain tumours, stimulant drug use (e.g., cocaine), venous thrombosis• Key risk factors: hypertension, smoking, excess alcohol (>37.5 units/week), family history, female sex, Afro-Caribbean ethnicity, age 45–70, previous SAH, large/irregular aneurysms📌 Pathophysiology• Sudden bleed = rapid ↑ intracranial pressure → brain compression & irritation• Blood in subarachnoid space irritates vessels, triggering vasospasm (can cause delayed cerebral ischaemia — DCI, a secondary “stroke” after the initial bleed)• Risk of rebleeding highest in first 24 hours📌 Classic Clinical Features• Sudden, severe “thunderclap” headache — “worst headache of my life”• Neck stiffness (meningism), photophobia, nausea/vomiting• Reduced consciousness, confusion, seizures• May be triggered by exertion or sexual activity• Sentinel bleed: warning headache days/weeks before major SAH📌 Differential Diagnosis• Migraine, cluster headache, primary cough/exertional/sexual headache• Meningitis, cerebral venous sinus thrombosis, carotid/vertebral dissection• Intracerebral or subdural haemorrhage, pituitary apoplexy, hypertensive crisis📌 Key Investigations• CT Head (non-contrast) ASAP: white signal in subarachnoid space – If CT <6h of onset and negative, SAH very unlikely — no LP needed – If CT >6h & negative, do LP after 12h to check for xanthochromia• CT/MR Angiography: locate aneurysm or AVM• DSA: gold standard, if needed• Routine bloods: FBC, U&Es, clotting, ECG (for cardiac changes)📌 Immediate Management• Urgent transfer to neurosurgical centre — time is brain!• Monitor GCS, pupils, BP, fluids, electrolytes• Nimodipine (oral calcium channel blocker) — start ASAP for ALL aneurysmal SAH, prevents vasospasm/DCI• Stabilise: keep systolic BP >100mmHg (acute), but often <140mmHg once stable (individualised)• Supportive: strong analgesia, antiemetics, bed rest, manage seizures/hydrocephalus📌 Definitive Treatment• Endovascular coiling: platinum coils fill aneurysm via catheter• Surgical clipping: metal clip closes aneurysm neck• For AVMs: surgical excision, embolisation, radiosurgery📌 Complications• Vasospasm → DCI (major cause of delayed disability/death)• Rebleeding (esp. before aneurysm secured, high mortality)• Hydrocephalus (acute or chronic), seizures/epilepsy• Cardiac complications: arrhythmias, stress cardiomyopathy• Electrolyte derangement: SIADH, cerebral salt-wasting• Cognitive impairment: memory, concentration, mood, fatigue• Dependency: up to 20% survivors need help with ADLs📌 Prognosis• Overall mortality >25% at 6 months (up to 15% die before hospital)• Survival much better (up to 85%) with timely aneurysm repair📎 More SAH Revision Resources:📝 Notes: https://www.passthemsra.com/topic/subarachnoid-haematoma-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/subarachnoid-haematoma-flashcards/💬 Accordion Q&A: https://www.passthemsra.com/topic/subarachnoid-haematoma-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/subarachnoid-haematoma-rapid-quiz/🎓 Neurology Course: https://www.passthemsra.com/courses/neurology-for-the-msra/#MSRA #SubarachnoidHaemorrhage #SAH #MSRARevision #MSRAFlashcards #MSRAQuiz #MSRAAccordions #Stroke #Neurosurgery #ThunderclapHeadache #Neurology #PassTheMSRA