Subarachnoid hemorrhage

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Subarachnoid hemorrhage
CT scan showing subarachnoid hemorrhage
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Thunderclap headache, vomiting, confusion, seizures
Complications	Hydrocephalus, cerebral vasospasm, hyponatremia
Onset	Sudden
Duration
Types	Traumatic subarachnoid hemorrhage, Aneurysmal subarachnoid hemorrhage
Causes	Head injury, ruptured cerebral aneurysm
Risks	Hypertension, smoking, alcohol use disorder, family history
Diagnosis	CT scan, lumbar puncture
Differential diagnosis	Meningitis, migraine, intracerebral hemorrhage
Prevention	Blood pressure control, smoking cessation
Treatment	Surgical clipping, endovascular coiling, nimodipine
Medication	Nimodipine, pain management
Prognosis	Variable, depends on severity and complications
Frequency	9 per 100,000 people per year
Deaths	40-50% mortality rate

Subarachnoid hemorrhage (SAH) is a serious, life-threatening type of stroke caused by bleeding into the space surrounding the brain, known as the subarachnoid space.<ref>Macdonald, RL,

 Subarachnoid hemorrhage, 
 Lancet, 
 2017,
 Vol. 389(Issue: 10069),
 pp. 655-666,
 DOI: 10.1016/S0140-6736(16)30668-7,</ref> This condition requires immediate medical attention and treatment to prevent severe disability or death.

File:Subarachnoid hemorrhage CT.jpg

Subarachnoid hemorrhage CT

Clinical Presentation

Symptoms of a subarachnoid hemorrhage can include a sudden severe headache (often described as "the worst headache of my life"), vomiting, loss of consciousness, and neurological symptoms such as blurred or double vision, difficulty speaking, and weakness or numbness on one side of the body.<ref>Kowalski, RG,

 Initial misdiagnosis and outcome after subarachnoid hemorrhage, 
 JAMA, 
 2004,
 Vol. 291(Issue: 7),
 pp. 866-869,
 DOI: 10.1001/jama.291.7.866,</ref>

File:Subarachnoid haemorrhage.jpg

Subarachnoid haemorrhage

Etiology

The most common cause of a subarachnoid hemorrhage is a ruptured aneurysm, a weakened and bulging section of a blood vessel. Other causes can include arteriovenous malformation (AVM), traumatic brain injury, or certain blood clotting disorders.<ref>van Gijn, J,

 Subarachnoid haemorrhage, 
 Lancet, 
 2007,
 Vol. 369(Issue: 9558),
 pp. 306-318,
 DOI: 10.1016/S0140-6736(07)60153-6,</ref>

Diagnosis

Diagnosis involves a series of tests to detect blood in the subarachnoid space and to identify the source of the bleeding. These tests can include a computed tomography (CT) scan, lumbar puncture (also known as a spinal tap), and cerebral angiogram.<ref>Connolly, ES,

 Guidelines for the management of aneurysmal subarachnoid hemorrhage, 
 Stroke, 
 2012,
 Vol. 43(Issue: 6),
 pp. 1711-1737,
 DOI: 10.1161/STR.0b013e3182587839,</ref>

Treatment

Treatment aims to stop the bleeding, prevent vasospasm (a complication characterized by narrowing of the blood vessels), and minimize brain damage. This typically involves surgery to repair the aneurysm, medications to control symptoms and prevent complications, and rehabilitative therapy to assist in recovery.<ref>Stienen, MN,

 Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage: Analysis of a Nationwide Database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]), 
 Stroke, 
 2018,
 Vol. 49(Issue: 2),
 pp. 333-340,
 DOI: 10.1161/STROKEAHA.117.019339,</ref>

Prognosis

Prognosis following a subarachnoid hemorrhage depends on a number of factors including the patient's age, general health, and the severity of the hemorrhage. Despite improvements in medical and surgical treatment, SAH remains a condition with high mortality and morbidity.<ref>Etminan, N,

 Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population: a systematic review and meta-analysis, 
 JAMA neurology, 
 2019,
 Vol. 76(Issue: 5),
 pp. 588-597,
 DOI: 10.1001/jamaneurol.2018.4613,</ref>

Prevention

Prevention of SAH is primarily focused on controlling risk factors for aneurysm formation and rupture, such as hypertension and smoking. In some cases, screening and preventive treatment may be recommended for individuals with a family history of aneurysmal SAH.<ref>Vlak, MH,

 Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis, 
 Lancet neurology, 
 2011,
 Vol. 10(Issue: 7),
 pp. 626-636,
 DOI: 10.1016/S1474-4422(11)70109-0,</ref>

See Also

• Aneurysm
• Stroke
• Cerebrovascular Diseases
• Neurosurgery

References

<references/>

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