Subarachnoid Haemorrhage

e.g. - within a Sylvian fissure -middle cerebral aneurysm

CT Scan

Confirms the diagnosis of SAH in 95% (if within 48 hours of the bleed).

- over the cortical sulci

- within the ventricular system

INVESTIGATIVE APPROACH (contd)

Age limit for neurosurgical referral. Although mortality and morbidity increase with age, with modern anaesthetic and operative techniques, many surgeons may even consider patients even over the age of 70 for further investigation with a view to operation, provided their clinical state is satisfactory.

CT Scan

Confirms the diagnosis of SAH in 95% (if within 48 hours of the bleed).

Blood restricted to the interpeduncular region and not extending into the lateral Sylvian or interhemispheric fissures (i.e. a 'perimesencephalic' pattern) is usually associated with a negative angiogram, but angiography is still required to exclude a basilar aneurysm.

MRI scan

Not routinely used, but in patients with multiple aneurysms, MRI performed several days after the bleed may provide greater sensitivity than CT in detecting small areas of subarachnoid clot and help determine the particular lesion responsible.

Angiography

Angiography is usually carried out at the earliest convenience, although in patients in poor clinical condition, the clinician may prefer to delay investigation until improvement has occurred. If a patient deteriorates from the mass effect of an intracranial haematoma, then emergency angiography is required prior to any decompressive operation. 273

Blood may be widely distributed - throughout the basal cisterns, Sylvian and interhemispheric fissures or more localised aiding identification of the site of the ruptured aneurysm e.g. - within a Sylvian fissure -middle cerebral aneurysm

CT also identifies other associated lesions

- hydrocephalus

- intracerebral haematoma

- tumour

- arteriovenous malformation

- within the interhemispheric fissure -anterior communicating aneurysm

- within the ventricular system

- over the cortical sulci

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