79 yr old male presented with severe headache and vomiting.vitals normal.GCS 15/15.Next step in management?



Spontaneous SAH,any history of trauma?? Bleed seen in basal cisterns Get an CT or MR angio done to rule out aneurysm bleed.Start calcium channel blockers(nimodipine),AEDs,Mannitol.Watch for GCS.ICU admission.


Extensive SAH with mild hydrocephalus. Blood in interhemipherical fissure in the frontal area.Blood in the posterior horn of rt lateral ventricle. ACAaneurysm is possible.Ref to Neurosurgeon& interventional radiologist for angio.DSA is ideal.Meanwhile start Nomodipin 60 mg4th hrly with BP monitoring .Start anticonvulsant.Transfer the case to neurosurgical I CU

SAH + INTRAVENTRICULAR EXTENSION ( Look at Rt occipital horn of lateral Ventricle) + LT parietal Haemorrhagic contusions , so MUST R/O Traumatic etiology. Treatment : conservative at present. AED+NIMODIPINE+ ANALGESICS + STOOL SOFTENER + IVF to maintain proper Hydration + Early Neurosurgery referral for DSA / MRA / 3DCT ANGIO & coiling of aneurysm if any

communicating hydrocephalus

Diffuse SAH Suggest: CT angio

This is diffuse sub arachnoid hemorrhage

There is SAH all over more on the left with bleed possibly from MCA, however put him nimodepine,Phenytoin,low dose mannitol see his BP if elevated don't drop it drastically ,if you drop it drastically then you would face. Ischemia

Diffuse SAH

SAH HHH therapy

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Communicating Hydrocephalus
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