Obligatory medical device diagnostics. Computed tomography of the skull (cranial CT or cCT) – sensitivity is 95% in the first 24 hours → diagnostic measure of first choice in the acute phase after subarachnoid hemorrhage (SAB). If necessary, magnetic resonance imaging of the skull (cranial MRI or cMRI) – for differential diagnosis or in subacute … Subarachnoid Hemorrhage: Diagnostic Tests
To prevent recurrent bleeding (rebleeding/rebleeding), a ruptured (ruptured) aneurysm must be rapidly separated from the bloodstream. This can be done surgically by clipping or endovascularly (“within a vessel”) by coiling (within the first 72 hours after the onset of the first symptoms, i.e. before the onset of possible vasopasms). The earlier a ruptured aneurysm is … Subarachnoid Hemorrhage: Surgical Therapy
To prevent subarachnoid hemorrhage (SAB) from aneurysm rupture, attention must be paid to reducing individual risk factors. Behavioral risk factors Recreational drug use Alcohol abuse (alcohol dependence) Tobacco (smoking) Prevention factors Blood pressure within normal range
The following symptoms and complaints may indicate subarachnoid hemorrhage (SAB): Leading symptoms Acute annihilation headache (primary thunderclap headache) – sudden onset, very severe headache that reaches peak pain within the first 60 seconds; caveat: SABs can also present with headaches that are not as severe or develop slowly Meningismus (painful neck stiffness). Other symptoms Signs … Subarachnoid Hemorrhage: Symptoms, Complaints, Signs
Pathogenesis (development of disease) In the setting of aneurysm rupture (rupture of a pathologic/diseased bulge in an arterial wall within the skull), which is the most common cause of subarachnoid hemorrhage, hemorrhage occurs into the fluid-filled subarachnoid space (i.e., hemorrhage outside the brain). The subarachnoid space surrounds the brain (Latin cerebrum) and spinal cord (Latin … Subarachnoid Hemorrhage: Causes
General measures Bed rest Pressor acts (vomiting, defecation) should be avoided → use of antiemetics (anti-nausea and anti-vomiting pharmaceuticals), laxatives (laxatives) if necessary. Securing or stabilization of vital functions (respiration, body temperature, circulation) – intubation in case of GCS* ≤ 12 or respiratory insufficiency (inability of the lungs to absorb sufficient oxygen from the ambient … Subarachnoid Hemorrhage: Therapy
The following forms of subarachnoid hemorrhage (SAB) are classified according to cause: Nontraumatic (spontaneous) subarachnoid hemorrhage. Aneurysmal SAB (85% of cases). Rupture (rupture) of a cerebral aneurysm Bleeding is most severe in the basal cisterns (cisterns = cavities around the brain) Non-aneurysmal SAB (15% of cases). Perimesencephalic SAB Blood pools around the mesencephalon (midbrain) and … Subarachnoid Hemorrhage: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: Assessment of consciousness or severity of subarachnoid hemorrhage using the “World Federation of Neurosurgical” (WFNS) classification – oriented to the Glasgow Coma Scale (GCS; scale for estimating a disorder of consciousness). General physical examination – including blood pressure, pulse, body weight, height; furthermore: … Subarachnoid Hemorrhage: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count [leukocytosis (increase in the number of leukocytes (white blood cells)] Electrolytes – sodium [hyponatremia/sodium deficiency] CSF puncture (collection of cerebrospinal fluid by puncture of the spinal canal) for CSF diagnosis – in the absence of evidence of a bleeding source by imaging techniques. After … Subarachnoid Hemorrhage: Test and Diagnosis
Therapeutic targets Safeguarding or stabilization of vital functions (respiration, body temperature, circulation). Avoidance of recurrent hemorrhage (new bleeding/post-bleeding) (often in the first 24 hours). Reduction of intracranial pressure Avoidance of complications, v. a. hydrocephalus (pathological dilation of the fluid spaces (cerebral ventricles) of the brain filled with cerebrospinal fluid), vasospasms (vascular spasms) and epileptic seizures … Subarachnoid Hemorrhage: Drug Therapy
The medical history represents an important component in the diagnosis of subarachnoid hemorrhage (SAB). The patient is admitted to the hospital as a medical emergency. If the patient is unresponsive, the case history must be taken with relatives or contacts (= external case history). Family history Are there frequent cardiovascular diseases, neurological diseases or tumor … Subarachnoid Hemorrhage: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Metabolic derangements, e.g., in the setting of diabetes mellitus (diabetic coma) or liver disease, in which there may be impaired consciousness with emesis (vomiting) Cardiovascular system (I00-I99). Intracerebral hemorrhage (ICB; cerebral hemorrhage). Cerebral sinus vein thrombosis (SVT) – occlusion of a cerebral sinus (large venous blood vessels of the … Subarachnoid Hemorrhage: Or something else? Differential Diagnosis