11/3/14 - SAH

Nothing much to say... this will be my stroke diary to help myself remember that I can learn everyday at least 10 new things and try to keep track on it. It will also help me to go back and quickly review what I have written and learned recently. Hopefully if you want to join me in my journey may help you to learn something new everyday about stroke.

Thanks,

The Fellowship of The Stroke

11/3/14

1) Non traumatic hemorrhagic stroke accounts for about 1-7% of all strokes. The peak age range for aneurysmal SAH is 50-60 years and it is more common in woman and blacks. Patients more than 50 yo with large posterior circulation aneurysms are at the greatest risk for both rupture and repair complications

2) Modifiable risks factors: Cigarette smoking, HTN, moderate to heavy ETOH use, cocaine use and endocarditis.

3) The 2 gradient scales for subarachnoid aneurysms are: Haunt and Hess grading scale for SAH and the World Federation of Neurological Surgeons Subarachnoid Grade. See below

4) The lifetime risk for AVM bleed is 105 minus the patient age. 

5) The Spetzler-Martin AVM grading scale assess surgical risk: < 3cm= 1 point, 3 to 6 cm= 2 points, > 6cm= 3 points; eloquent location= 1 point, non eloquent location= 0 point; deep venous drainage = 1 point, superficial venous drainage= 0 point. Increasing points correlate with a higher risk for resection. 

6) In SAH sensitivity of CT scan drops to 60% 5 days after ictus. 

7) The modified Fisher scale incorporates the risk of vasospasm due to both SAH and IVH 

8) Seizures occur in 10% of pts at ictus, 4% during hospital stay and another 7% have late seizures

9) Hyponatremia following SAH is usually due to CSW (cerebral salt wasting) more than SIADH. Volume status will be normal or high in SIADH. Daily inputs and outputs can help determine the etiology.

10) Vasospasm typically occurs between 3-14 days after SAH ictus.