Subarachnoid Hemorrhage
Summary: <br> History<br> <br> <br> <br> * Sudden and maximal in onset* Compared to previous headaches* Family history of aneurysm* Associated Symptoms* Photophobia* Visual Changes* Neck Stiffness<br> <br> <br> <br> Exam<br> <br> <br> <br> * Full neuro examination* Cranial nerves* Visual fields* Speech* Cerebellar (finger-nose)* Motor* Sensation* Gait<br> <br> <br> <br> Testing Plan<br> <br> <br> <br> * Non-contrast head CT* Excellent sensitivity <6 hours from onset* Lumbar puncture* >100 RBCs in tube 4* Can be difficult to interpret after a traumatic lumbar puncture* Xanthochromia<br> <br> <br> <br> Treatment Plan<br> <br> <br> <br> * Prevent rebleeding* Keep SBP <140* Nicardipine* Reverse any anticoagulants* Vitamin K* Prothrombin complex concentrate* Fresh frozen plasma* Prevent vasospasm* Nimodipine PO* Prevent delayed ischemia* Avoid hyperthermia* Avoid hyper/hypoglycemia* Prevent seizures* Levetiracetam (aka Keppra)<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Ottawa Subarachnoid Hemorrhage <a href="https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation#pearls-pitfalls">(MDCalc)</a><br>
