Definition

It is the bleed in Subarachnoid space(The space between arachnoid and pia matter)

Risk factors

  • Intracranial aneurysms
  • Trauma
  • Vascular malformations (arteriovenous malformations)
  • Moyamoya syndrome
  • Coagulopathy
  • Extension of intracerebral hematoma.
  • Hypertension
  • Polycystic kidneys
  • Coarctation of aorta

 

Clinical Features

  • Severe headache
  • Nausea, vomiting
  • Syncope
  • Third and sixth cranial nerve palsies
  • Seizures
  • Lethargy
  • Meningism
  • Photophobia
  • Neck stiffness

Preceding symptoms

  • Headache
  • Diplopia especially during exertion

 

Investigations

  • Bloods- FBC, Renal functions, Blood sugars
  • CT scan
  • ECG
  • Chest X-ray
  • Lumbar puncture if CT normal and no focal neurological signs and no papilledema

Grading 

Fisher Scale for Grading SAH on Admission CT Scan

Grade        CT Finding

Grade 1       No blood visualized

Grade 2       Layer of blood (over interhemispheric fissure, insular cistern, ambient cistern) less than 1 mm thick 

Grade 3       Localized clots or layer of blood 1 mm or greater in thickness 

Grade 4       Diffuse or no subarachnoid blood, but with intracerebral or intraventricular clots 

 

 

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