1. 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

2. Aneurysmal SAH ANNUAL RATE 10-30% 10%DIE BEORE REACHIUNG THE HOSPITAL Peak age 55-60 years 20% can occur in age 15-45y Old age has a higher proportion with a severe neurological grade

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

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

5. Clinical picture HeadacheMeningismusComa Ocular haemorrhage

7. Investigations ImagesLPANGIOMR-ANGIO

9. 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

10. G0: unruptured G1a

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

12. Rebleeding Vasospasm( DIND)

13. TREATMENT OF VASOSPASM PREVENTION HYPERDYNAMIC THERAPY Hypertension, hypervolemia hemodilution

14. Cerebral aneurysm Treatment options