By Dimity McCracken
These are images from real ICU patients. The stories and details are changed to preserve confidentiality.
A 40yo woman presented to her GP complaining of severe headache. Further history revealed she was a smoker & only social drinker. She had suffered migraines as a young adult, but had had none for the last 5yrs. She mentioned that she was under significant stress at the moment due to divorce procedings. Her neurological examination was unremarkable. The GP sent her home, planning outpatient investigations including CT head.
3days later the woman collapsed at home. She was brought to ED: GCS 7, no focal neurology, & examination was otherwise normal apart from mild hypertension (145/87mmHg). She was intubated for airway protection & sent to CT.
What does the CT scan show?
Acute aneurysmal subarachnoid haemorrhage.
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Oli Flower’s awesome SAH PK’s. These cover initial management, ICU management, vasospasm, complications, & prognostication.
Grading of SAH:
-World Federation of Neurosurgeons WFNS SAH Grading
–Hunt & Hess Scale
-From the fabulous Radiopaedia.org is the Fischer Scale as well as more on SAH