Subarachnoid hemorrhage (SAH) Miniatlas

Subarachnoid hemorrhage (SAH) is a serious, life-threatening type of stroke caused by bleeding into the space surrounding the brain. Causes, diagnosis and .
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Hence, people who have undergone coiling are typically followed up for many years afterwards with angiography or other measures to ensure recurrence of aneurysms is identified early.

Subarachnoid hemorrhage (SAH) | Mayfield Brain & Spine, Cincinnati, Ohio

Vasospasm , in which the blood vessels constrict and thus restrict blood flow , is a serious complication of SAH. It can cause ischemic brain injury referred to as "delayed ischemia" and permanent brain damage due to lack of oxygen in parts of the brain. Delayed ischemia is characterized by new neurological symptoms, and can be confirmed by transcranial doppler or cerebral angiography. About one third of people admitted with subarachnoid hemorrhage will have delayed ischemia, and half of those have permanent damage as a result.

The use of calcium channel blockers , thought to be able to prevent the spasm of blood vessels by preventing calcium from entering smooth muscle cells, has been proposed for prevention.

Subarachnoid Hemorrhage

Some older studies have suggested that statin therapy might reduce vasospasm, but a subsequent meta-analysis including further trials did not demonstrate benefit on either vasospasm or outcomes. A protocol referred to as "triple H" is often used as a measure to treat vasospasm when it causes symptoms; this is the use of intravenous fluids to achieve a state of hypertension high blood pressure , hypervolemia excess fluid in the circulation , and hemodilution mild dilution of the blood.

If the symptoms of delayed ischemia do not improve with medical treatment, angiography may be attempted to identify the sites of vasospasms and administer vasodilator medication drugs that relax the blood vessel wall directly into the artery.


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Angioplasty opening the constricted area with a balloon may also be performed. Hydrocephalus obstruction of the flow of cerebrospinal fluid may complicate SAH in both the short and long term. It is detected on CT scanning, on which there is enlargement of the lateral ventricles. If the level of consciousness is decreased, drainage of the excess fluid is performed by therapeutic lumbar puncture, extraventricular drain a temporary device inserted into one of the ventricles , or occasionally a permanent shunt.

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People have often been treated with preventative antiepileptic medications. SAH is often associated with a poor outcome. So-called "angiogram-negative subarachnoid hemorrhage", SAH that does not show an aneurysm with four-vessel angiography, carries a better prognosis than SAH with aneurysm, but it is still associated with a risk of ischemia, rebleeding, and hydrocephalus.

The prognosis of head trauma is thought to be influenced in part by the location and amount of subarachnoid bleeding. There is also modest evidence that genetic factors influence the prognosis in SAH. For example, having two copies of ApoE4 a variant of the gene encoding apolipoprotein E that also plays a role in Alzheimer's disease seems to increase risk for delayed ischemia and a worse outcome.

Neurocognitive symptoms, such as fatigue , mood disturbances, and other related symptoms are common sequelae. Even in those who have made good neurological recovery, anxiety, depression, posttraumatic stress disorder , and cognitive impairment are common; 46 percent of people who have had a subarachnoid hemorrhage have cognitive impairment that affects their quality of life. More than a quarter of people with a previous SAH may develop hypopituitarism deficiencies in one or more of the hypothalamic-pituitary hormones such as growth hormone , luteinizing hormone , or follicle-stimulating hormone.

According to a review of 51 studies from 21 countries, the average incidence of subarachnoid hemorrhage is 9. Studies from Japan and Finland show higher rates in those countries South and Central America, in contrast, have a rate of 4. Although the group of people at risk for SAH is younger than the population usually affected by stroke, [63] the risk still increases with age. Young people are much less likely than middle-age people risk ratio 0.

Genetics may play a role in a person's disposition to SAH; risk is increased three- to fivefold in first-degree relatives of people having had a subarachnoid hemorrhage. Overall, about 1 percent of all people have one or more cerebral aneurysms. Most of these are small and unlikely to rupture. Symonds — gave a complete account of all major symptoms of subarachnoid hemorrhage, and he coined the term "spontaneous subarachnoid hemorrhage". The first surgical intervention was performed by Norman Dott, who was a pupil of Harvey Cushing then working in Edinburgh.

He introduced the wrapping of aneurysms in the s, and was an early pioneer in the use of angiograms. In , the Russian neurosurgeon Zubkov and colleagues reported the first use of transluminal balloon angioplasty for vasospasm after aneurysmal SAH. Guido Guglielmi introduced his endovascular coil treatment in From Wikipedia, the free encyclopedia. Emergency medicine clinics of North America. Oxford Handbook of Clinical Medicine, 7th edition. Journal of Neurology, Neurosurgery, and Psychiatry. Electrothrombosis of saccular aneurysms via endovascular approach: American Journal of Neuroradiology.

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