SAQ 421 – Neurology – subarachnoid haemorrhage on CT

Neurology – subarachnoid haemorrhage on CT.

a. CT findings

• Acute hyperdense subarachnoid blood in the basal cisterns.
• Blood extends into the Sylvian fissures/suprasellar cistern region.
• Ventricles are visible with concern for early hydrocephalus.
• No large extradural/subdural collection is shown on this slice.
• No major midline shift is evident on this slice.

b. Diagnosis

• Aneurysmal subarachnoid haemorrhage, likely high grade given confusion.

c. Neuroprotection

• Give analgesia and antiemetics, and avoid agitation/straining.
• Elevate head, maintain normoxia, normocapnia, normoglycaemia, and normothermia.
• Control blood pressure while maintaining cerebral perfusion.
• Give nimodipine if not contraindicated.
• Treat seizures if present.
• Urgent neurosurgical/neurointerventional referral and ICU-level monitoring.

d. Antihypertensive

• Labetalol 10-20 mg IV boluses titrated to effect, or infusion according to local protocol.
• An alternative is nicardipine infusion titrated to target if available.

e. Target systolic range

• Aim for approximately 120-160 mmHg systolic before aneurysm securing, avoiding hypotension.