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!

"#
!%& '(')*+,-. *'/0,((*'1/
uenluon
Subarachnold haemorrhage ls dened as
&2//.-+1 -+3, 3*/ 4%&'(')*+,-. 45')/ 6-3*-+
3*/ -+3(')('+-'2 7'%23.
8evlew of anaLomy
lncldence
9.1 per 100,000 annually
8lsk lncreases ln older age - 60 hlgher ln age
above 80
8lsk of SAP ls relauvely hlgher ln women over
33 years Lhan men
8lsk facLors
8ace
Sex
Age
Ceneucs
Smoklng
Alcohol
Luology
Pead Lrauma
lnLra cranlal aneurysm
lncreased blood
pressure
lncreased blood ow
8lood vessel dlsorders
Ceneuc
lnfecuous
895/4 ,: '+/%(940
8erry (saccular)aneurysm
ClanL (fuslform) aneurysm
Mycouc aneurysm
CharcoL -8ouchard aneurysm
1raumauc aneurysm
895/4 ,: '+/%(940
;,)'<,+

='3*,5*94-,2,19
Mass eecL 8upLure eecL

8upLure of cerebral aneurysm

8leedlng lnLo subarachnold space

SLroke syndrome develops

lncreased lC


Text
>2-+-)'2 :/'3%(/4
!9053,04?

Sudden severe headache wlLh or wlLhouL LCC
AssoclaLed wlLh vomlung, phoLophobla,
drowslness, resLlessness and aglLauon
Some ume - low back paln and bllaLeral
radlcular leg paln (Splnal SAP)
!-1+4?
neck suness
lmpalred level of consclousness ln some
pauenLs
Subhyalold haemorrhage (opuc fundus)
kernlgs slgn
8rudzlnskl's slgn
Cranlal nerve lll palsy

Cradlng of SAP
PunL-Pass classlcauon
>'3/1,(9 >(-3/(-'
Crade 1 AsympLomauc or mlld headache
Crade 2 ModeraLe-Lo-severe headache, nuchal rlgldlLy,
and no neurologlcal declL oLher Lhan posslble
cranlal nerve palsy

Crade 3 Mlld alLerauon ln menLal sLaLus (confuslon, leLhargy),
mlld focal neurologlcal declL
Crade 4 SLupor and/or heml paresls
Crade 3 ComaLose and/or decerebraLe rlgldlLy
@-'1+,4<) 5(,)/.%(/4
CompuLed Lomography
Lumbar puncLure
Cerebral anglography
"+1-,1('5*9
>,052-)'<,+4

8e-bleedlng
Pydrocephalus
lnLravenLrlcular haemorrhage
lncreased lnLracranlal pressure
lnLracerebral hemorrhage
Selzures
Cerebral vasospasm
ManagemenL
A/.-)'2 0'+'1/0/+3?

AcuLe care :
lf pauenL ls comaLose - venulaLor asslsLance
A8C analysls
Lmergency C1 scan
Cardlac monlLorlng
aln managemenL
1he goal of LreaLmenL : Lo prevenL re bleedlng
and cerebral vasospasm
8e bleedlng
8ed resL
8ecomblnanL acuvaLor facLor vll

!%(1-)'2 0'+'1/0/+3
Cllpplng of aneurysm
Colllng of aneurysm
B'4,45'40


SLerolds
AnuhyperLenslve
Anupyreucs
AnuconvulsanLs
Analgeslcs
Sedauves
SLool soeners
8esplraLory compllcauon
venous compllcauon
Cardlovascular compllcauon
lluld and elecLrolyLe dlsLurbance
CasLrolnLesunal compllcauon
Summary

uenluon
lncldence
8lsk facLors
Luology
1ypes
aLhophyslology
Cllnlcal manlfesLauon
ManagemenL
Compllcauon

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