Subarachnoid Haemorrhage and Intracranial Haemorrhage

The answer first

Spontaneous intracranial haemorrhage divides into two mechanistically and therapeutically distinct syndromes: aneurysmal subarachnoid haemorrhage (SAH) from rupture of a saccular intracranial aneurysm, and spontaneous intracerebral haemorrhage (ICH) from rupture of small deep vessels damaged by hypertensive arteriopathy or cerebral amyloid angiopathy. The answer-first physician approach is to recognise the pattern of a thunderclap headache or acute focal deficit, secure the diagnosis with non-contrast computed tomography (CT), then act with three time-critical levers — blood-pressure control, urgent vascular imaging in suspected SAH, and early definitive aneurysm obliteration in confirmed SAH — while starting nimodipine for delayed cerebral ischaemia prevention. ^{[1] [2] [9]}

For the FRACP candidate the intracranial haemorrhage long case rewards a tight one-sentence synthesis ("a 58-year-old hypertensive woman with a WFNS grade 2 aneurysmal subarachnoid haemorrhage from a ruptured anterior communicating artery aneurysm, now day 5 with delayed cerebral ischaemia"), a problem list ordered by threat, and a plan that integrates resuscitation, neurocritical care, neurointerventional and neurosurgical pathways, plus secondary prevention and rehabilitation. ^{[1] [9]} The trap is treating "a bleed" as a unitary diagnosis: SAH and ICH are managed in entirely different ways, and the threshold, target and timing of blood-pressure lowering, the role of surgery, and the indication for nimodipine all hinge on the mechanism. ^{[2] [9]}

References13ShowHide

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