Hi all,

My second post of this week:

Subarachnoid Haemorrhage (SAH)

1) Diagnosis:
- Full Neurological examination
- Ongoing neurological observation (E.g. GCS)
- CT Scan
i. Confirm the diagnosis in 95% of causes
ii. Blood may be widely distributed or more localized
iii. Can also identify other conditions such as hydrocephalus and ICH
- Cerebral Angiogram
i. Undertake by all patients
ii. Four vessel angiography
- Lumbar Puncture
i. Presence of blood in CSF is a positive result
ii. Patient has LP done needs to RIB at least 6 hours
- TCD’s
i. Measure the velocity of blood flow in intracranial vessels
ii. A reading of 120cm/s is significant

2) Things need to consider when seeing patients who has SDH on ward
i. Make sure you know what type of surgery the patient had done, E.g.) If
patient had a craniectomy, they are not allowed to sit up without a helmet
ii. No driving or RTW for at least 6 weeks (For discharge planning)
iii. Fatigue can be a problem for some months post bleed (Impact on your clinical
decision)
iv. Always ask your patient whether they have any dizziness; you need to know
whether the dizziness is position related or movement related. From my 4
weeks experience, it is not uncommon for patient to have some forms of
vestibular impairments.