Subarachnoid Hemorrhage

Posted by e-Medical PPT Saturday, September 25, 2010
Subarachnoid hemorrhage is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. This may occur spontaneously, usually from a ruptured cerebral aneurysm, or may result from head trauma.SAH is a form of stroke and comprises 1–7% of all strokes.It is a medical emergency and can lead to death or severe disability—even when recognized and treated at an early stage.
The classic symptom of subarachnoid hemorrhage is thunderclap headache.This headache often pulsates towards the occiput.Vomiting may be present, and some may have seizures.Confusion, decreased level of consciousness or coma may be present, as may neck stiffness and other signs of meningism.Neck stiffness usually presents six hours after initial onset of SAH.Isolated dilation of a pupil and loss of the pupillary light reflex may reflect brain herniation as a result of rising intracranial pressure.Oculomotor nerve abnormalities may indicate bleeding from the posterior communicating artery.
In 85% of cases of spontaneous SAH, the cause is rupture of a cerebral aneurysm—a weakness in the wall of one of the arteries in the brain that becomes enlarged.The remainder are due to other disorders affecting the blood vessels (such as arteriovenous malformations), disorders of the blood vessels in the spinal cord, and bleeding into various tumors.Traumatic SAH (tSAH) usually occurs near the site of a skull fracture or intracerebral contusion.
The diagnosis is generally confirmed with a CT scan of the head, or occasionally by lumbar puncture.Lumbar puncture will show evidence of hemorrhage in 3% of people in whom CT was found normal.At least three tubes of CSF are collected.If an elevated number of red blood cells is present equally in all bottles, this indicates a subarachnoid hemorrhage.The CSF sample is also examined for xanthochromia.Treatment is by prompt neurosurgery or radiologically guided interventions with medications and other treatments to help prevent recurrence of the bleeding and complications.

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