Table of contents
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Subarachnoid Hemorrhage
- Definitions:
- "Thundercalp Headache", "Worst headache of life"
- Defined as: Severe headache that reaches maximum intensity within 60s of onset.
- 25% of "Thunderclap Headache" is SAH --> Neurosurgical Emergency
- Other Dx:
- dural sinus
- thrombosis
- meningitis
- migraine
- Diagnosis:
- 1st test: Non-Contrast Head CT
- 2nd test: (if CT negative) --> Lumbar Puncture
- Evaluate for erythrocytes or xanthochromia.
- Xanthochromia describes a yellow discoloration of the CSF from breakdown of erythrocytes, which may not develop for at least 6 hours after the initial event.
- Normal CSF has a very good negative predictive value (generally excludes)
- 3rd Test: (If all normal) --> rule out other causes:
- MRI Head
- MRI Angiography: Cervicocephalic arterial dissection, internal carotid artery dissection (often Horners)
- MRI Venography: Deep venous thrombosis and cerebral venous sinus thrombosis.
- Treatment:
- Neurosurgical referral
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