Subarachnoid hemorrhage physical examination: Difference between revisions
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*Neurologic examination | *Neurologic examination | ||
===Vital Signs=== | ===Vital Signs=== | ||
As a result of the bleeding | As a result of the bleeding | ||
*Mild to moderate blood pressure (BP) elevation | |||
*Temperature elevation (secondary to chemical meningitis after the fourth day following bleeding). | |||
*[[Tachycardia]] (several days after the occurrence of a hemorrhage) | |||
=== Level of consciousness === | === Level of consciousness === | ||
Revision as of 21:01, 8 December 2016
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Subarachnoid Hemorrhage Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012)
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Case Studies |
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Subarachnoid hemorrhage physical examination On the Web |
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American Roentgen Ray Society Images of Subarachnoid hemorrhage physical examination |
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Risk calculators and risk factors for Subarachnoid hemorrhage physical examination |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
In a patient with thunderclap headache, none of the signs mentioned are helpful in confirming or ruling out hemorrhage, although a seizure makes bleeding from an aneurysm more likely. Physical examination should include vital sign, level of consciousness (Glasgow Coma Scale (GCS)) eye examination, and neurologic examination.[1][2][3][4]
Physical Examination
In a patient with thunderclap headache, none of the signs mentioned are helpful in confirming or ruling out hemorrhage, although a seizure makes bleeding from an aneurysm more likely.
Physical examination should include:[1][2][3][4]
- Vital signs
- Level of consciousness (Glasgow Coma Scale (GCS))
- Eye examination
- Neurologic examination
Vital Signs
As a result of the bleeding
- Mild to moderate blood pressure (BP) elevation
- Temperature elevation (secondary to chemical meningitis after the fourth day following bleeding).
- Tachycardia (several days after the occurrence of a hemorrhage)
Level of consciousness
Level of consciousness (Glasgow Coma Scale (GCS))
Eyes
Oculomotor nerve abnormalities (affected eye looking downward and outward, pupil widened and less responsive to light) may indicate a bleed at the posterior inferior cerebellar artery.
Neurologic
Bleeding into the subarachnoid space may occur as a result of injury or trauma. SAH in a trauma patient is often detected when a patient who has been involved in an accident becomes less responsive or develops hemiparesis or changed pupillary reflexes, and Glasgow Coma Score calculations deteriorate. Headache is not necessarily present.
Level of severity of neurological deficit (National Institutes of Health Stroke Scale (NIHSS))
References
- ↑ 1.0 1.1 Bos MJ, Koudstaal PJ, Hofman A, Breteler MM (2007). "Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam Study". Stroke. 38 (12): 3127–32. doi:10.1161/STROKEAHA.107.489807. PMID 17962600.
- ↑ 2.0 2.1 Hackam DG, Mrkobrada M (2012). "Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis". Neurology. 79 (18): 1862–5. doi:10.1212/WNL.0b013e318271f848. PMID 23077009. Review in: Evid Based Ment Health. 2013 May;16(2):54
- ↑ 3.0 3.1 Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001). "Spontaneous intracerebral hemorrhage". N Engl J Med. 344 (19): 1450–60. doi:10.1056/NEJM200105103441907. PMID 11346811.
- ↑ 4.0 4.1 Fisher CM (1971). "Pathological observations in hypertensive cerebral hemorrhage". J Neuropathol Exp Neurol. 30 (3): 536–50. PMID 4105427.