Neurology Exam Prep Podcast Episode 28: Subarachnoid Hemorrhage
Jan 9, 2021
A discussion on subarachnoid hemorrhage focusing on causes such as trauma and aneurysms. Topics include risk factors like smoking and hypertension, management strategies, severity scoring systems like the Hunt test, and advanced endovascular treatments. Also covers medical management of complications like re-bleeding and seizures.
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Bleed Pattern Predicts Cause
- Trauma causes cortical, diffuse subarachnoid blood while aneurysmal bleeds localize around the Circle of Willis.
- Aneurysms most commonly occur at AComm, PComm, MCA bifurcation, proximal ICA, and basilar tip locations.
Reduce Rupture Risk With BP Control And Smoking Cessation
- Counsel patients with aneurysms to stop smoking and control blood pressure to reduce rupture risk.
- Monitor unruptured aneurysms for growth, daughter domes, and consider family history and age in risk discussion.
Size, Shape, And Genetics Drive Rupture Risk
- Aneurysm size >7 mm and rapid growth increase rupture risk, as do daughter domes.
- Family history and genetic conditions (e.g., polycystic kidney disease, Ehlers-Danlos) raise likelihood of multiple aneurysms.