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Subarachnoid Haemorrhage
- spontaneous bleeding into subarachoid space
- dramatic onset
- incidence 6 per 100,000/year
- most occur 40-60%
- male 2x more likely than female
Cause
- rupture of aneurysm
- usually saccular "berry
aneurysms" on circle of Willis
- thought to occur through congenital weakness of arterial media
History
- very severe headache
- sudden onset
- often occipital region
- vomiting
- drowsiness
Examination
- neck stiffness
- Kernig's sign positive
- papilloedema
- retinal haemorrhage
- subhyaloid haemorrhage
Investigations
- CT scan
- carotid / vertebral angiography
Complications
Management
- interventional radiology
- surgery to clip bleeding aneurysm
- dexamethasone
- nimodipine
Prognosis
- 15% instantly fatal
- 25-50% die during first rupture
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