Subarachnoid hemorrhage Causes : -Trauma -Trauma -Spontaneous, ruptured aneurysms,AVM, vacuities, tumors, coagulation disorders,cerebral artery dissection, sickle cell disease, drugs, spinal AVM -Spontaneous, ruptured aneurysms,AVM, vacuities, tumors, coagulation disorders,cerebral artery dissection, sickle cell disease, drugs, spinal AVM

Aneurysmal SAH ANNUAL RATE 10-30% 10%DIE BEORE REACHIUNG THE HOSPITAL Peak age years 20% can occur in age 15-45y Old age has a higher proportion with a severe neurological grade

Risk factors for SAH Hypertension Oral contraceptives Substance abuse pregnancy and parturition

Outcome 10% die 10%mortality within first few days 30% moderate to severe disability

Clinical picture HeadacheMeningismusComa Ocular haemorrhage

Investigations ImagesLPANGIOMR-ANGIO

GRADING SAH Hunt& Hess G1 asymptomatic G2 moderate to severe headache nuchal rigidity nuchal rigidity G3 confusion G4 Stupor moderate to severe hemiparasis G5 deep coma

G0: unruptured G1a

ManagementConcerns Monitoring and tubes Admitting orders I V fluids MedicationOxygen Hyponatremia& cardiac problems

Rebleeding Vasospasm( DIND)

TREATMENT OF VASOSPASM PREVENTION HYPERDYNAMIC THERAPY Hypertension, hypervolemia hemodilution

Cerebral aneurysm Treatment options