Talk about SAH?
Best dx test? prognosis?
Often there is a recent moderate HA as a result of sentinel bleed. 60% of the SAH occur during physical activity (i.e. excersise, emotional strain, head trauma, defecation, coitus.
Common complications include partial seizures, hemiparesis, which can occur because of the vasospasm of blood vessels (most commonly with aneurysmal SAH, 4-14 days after the hemorrhage), extension of the hemorrhage in to the prynchema with edema.
Hyponatremia is seen often due to SIADH, cerebral salt wasting, and elevated ANP
communicating hydrocephalus is a common outcome because of the blockage of the subarachnoid granulation.
Non-contrast head CT can detect bleed with high sensitivity 24hrs after bleed and can detect it as late as a week later. Bleeding in the ventricle is worse prognosis and more related to hydrocephalous. A negative CT shold be confrimed with LP looking for xanthochromia with increased RBC cells.
Up to 60% of pt die in the first 30 days after SAH. 10% due without any warning.