 Bala murugan E

Msc . Nursing , AIIMS

,
Sub arachnoid haemorrhage
 Definition
• Subarachnoid haemorrhage is
defined as bleeding into the
subarachnoid space within the
intracranial vault.
Review of anatomy
 Incidence
• The incidence of subarachnoid
haemorrhage is 9.1 per 100,000
annually.
• Risk increases in older age 60%
higher in age above 80
• Risk of SAH is relatively higher in
women over 55 years than men
•
 Risk factors
• Race
• Sex
• Age
• Genetics
• Smoking
• Alcohol
 Etiology
• Head trauma
• Intra cranial
aneurysm
 Increased blood
pressure
 Increased blood
flow
 Blood vessel
disorders
 Genetic
 Infectious
 Types of aneurysm
• Berry (saccular)aneurysm
• Giant (fusiform) aneurysm
• Mycotic aneurysm
• Charcot –Bouchard aneurysm
• Traumatic aneurysm
•
Location
 Pathophysiology
 Mass effect
Rupture effect


 Rupture of cerebral aneurysm



 Bleeding into subarachnoid space



 Stroke syndrome develops



 Increased ICP

 Clinical features
• Symptoms
• Sudden severe headache with or
without LOC
• Associated with
vomitting,photophobia,drowsiness,r
estlessnesand agitation
• Some time lowback pain and bilateral
radicular leg pain.
• Signs
• Neck stiffness
• Impaired level of consciousness in
some patients
• Subhyaloid haemmorhage on optic
funduscopy
Kernigs sign
Brudzinskis sign
Cranial nerve III palsy
 Grading of SAH
Hunt-Hass classification
Category Criteria
Grade 1 Asymptomatic or mild headache
Grade 2 Moderate-to-severe headache, nuchal rigidity,
and no neurological deficit other than
possible cranial nerve palsy

Grade 3 Mild alteration in mental status (confusion,

lethargy), mild focal neurological deficit

Grade 4 Stupor and/or hemi paresis

Grade 5 Comatose and/or decerebrate rigidity
 Diagnostic procedures
• Computed
tomography
• Lumbar puncture
• Cerebral
angiography
•
 Management
• Medical management
• Acute care
• If patient is comatose ventilator
assistance
• ABG analysis
• Emergency CT scan
• Cardiac monitoring
• Pain management
•
• The goal of treatment is to prevent re
bleeding and cerebral vasospasm
• Re bleeding
• Bed rest
• Recombinant activator factor VII


•
•
•
Vasospasm
• Calcium channel blocker
• Smooth muscle relaxants
• Triple H therapy
 Hypervolumia
 Hypertension
 Hemodilution
• Steroids
• Antihypertensive
• Antipyretics
• Anticonvulsants
• Analgesics
• Sedatives
• Stool softeners
Surgical management
clipping of aneurysm
Coiling of aneurysm
 Nursing management
• Altered neurological function related
haemorrhage from cerebral
aneurysm
• Pain due to cerebral haemorrhage
• Sensory input distortion related to
meningeal irritation
• Potential for seizure related to
cerebral irritation
• Potential for neurological
deterioration related to re bleeding
or cerebral vasospasm
 Complication

• Rebleeding
• Hydrocephalus
• Intraventricular haemorrhage
• Increased intracranial pressure
• Intracerebral hemorrhage
• Seizures
• Cerebral vasospasm
•
•
• Respiratory complication
• Venous complication
• Cardiovascular complication
• Fluid and electrolyte disturbance
• Gastrointestinal complication
•
 Summary

• Definition
• Incidence
• Risk factors
• Etiology
• Types
• Pathophysiology
• Clinical manifestation
• Management
• Complication
•