Subarachnoid Hemorrhage

EM Clerkship

Zack Olson, MD and Michael Estephan, MD

Education, Courses, Health & Fitness, Medicine

5 • 795 Ratings

🗓️ 20 May 2018

⏱️ 9 minutes

🔗️ Recording | iTunes | RSS

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Summary

History Sudden and maximal in onset Compared to previous headaches Family history of aneurysm Associated Symptoms Photophobia Visual Changes Neck Stiffness Exam Full neuro examination Cranial nerves Visual fields Speech Cerebellar (finger-nose) Motor Sensation Gait Testing Plan Non-contrast head CT Excellent sensitivity <6 hours from onset Lumbar puncture >100 RBCs in tube 4 Can be […]

Transcript

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0:00.0	Hello, med students. My name is Zach Olson and thank you for downloading this week's
0:07.0	episode of the EM Clerkship Podcast. Here's your case.
0:19.2	Okay, everybody, we've got a 43-year-old male.
0:21.6	Had a sudden onset of headache about an hour ago, 10 out of 10 on the pain states he feels like he got kicked in the head.
0:28.6	No trauma, emesis times two, slight isolated right pupil dilation and sluggish to reflex to light.
0:35.6	No history, no meds, no allergies, 180 over 90, pulse of 120, respiration is 20, 98% and 156 on the glucose.
0:43.3	Any questions?
0:45.3	Yeah, wife is waiting room.
0:49.3	Okay, thank you.
0:51.3	All right, what's your differential? Thank you.
0:55.7	All right.
0:57.2	What's your differential?
1:04.1	When a patient presents like this, I have a few things in mind myself.
1:09.0	Menagitis, strokes, maybe like a vascular dissection,
1:14.9	but one of the most important things on my differential is subarachnoid hemorrhage,
1:21.1	that sudden and severe headache, the king of bad headache causes.
1:29.5	These are usually caused by an aneurism on the circle of Willis that leaks or breaks open,
1:34.7	that blood floats around in the subarachnoid space, irritating the brain and then eventually settling into those cisterns.
1:37.2	And it's just really not good.
1:39.4	These patients don't do well.
1:41.8	Risk factors are family history, smoking, a few other things, plus that
1:46.7	worst risk factor of all, bad luck. And so that's what we're going to talk about this week,
	...

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