Introduction
A subarachnoid hemorrhage, or SAB for short, describes a bleeding into the so-called subarachnoid space in the skull due to a torn blood vessel. This is a medical emergency that should be treated immediately by a physician.
Symptoms
The skull cannot expand due to the bone, so that any increase in pressure leads to massive symptoms because the brain has little opportunity to avoid the pressure and the meninges cannot stretch. The increased pressure in the brain can lead to rapid death due to compression of important circulatory centers in the brain stem. About 50% of those affected report severe headaches, which can probably be explained by the stretch-related irritation of the extremely pain-sensitive meninges.
Another symptom is unconsciousness, which can be caused by the increasing pressure within the skull and on the brain structures. Another reason for unconsciousness and also death is the secondary occurrence of massive reactive vasoconstriction (vasospasms), which leads to an undersupply of blood (and thus vital oxygen) to the brain structures. This leads to the death of brain areas (ischemia).
Neck stiffness and vomiting are further indicators of a Sucharchanoidal bleeding, but a differential diagnostic clarification (is it really an SAB or can the present symptoms also indicate other diseases?) is essential. The SAB (Sucharchanoidal Hemorrhage) is clinically classified according to Hunt and Hess into the severity levels 1 to 5 (I to V), which can be used to determine the severity.
Therapy
If an SAH (subarachnoid hemorrhage) is diagnosed, the patient is immediately transferred to the intensive care unit where he is treated with medication (drugs for brain swelling and vascular spasms). Surgical treatment is performed to prevent recurrent bleeding (recurrent hemorrhage):
- Clipping: Closure of the aneurysm with a clamp
- Coiling: Sclerotherapy of the aneurysm by introducing a platinum spiral (the following coagulation processes lead to sclerotherapy)
Besides the acute treatment by coiling or clipping it is also important to treat so-called risk factors. A too high blood pressure is one of these factors.
However, it is problematic that the treatment of high blood pressure can sometimes cause low blood pressure. This can lead to a narrowing of the blood vessels after the previous bleeding and thus to reduced blood flow (ischemia). For this reason, many doctors are not in complete agreement as to which blood pressure values should be used for blood pressure therapy. A common medicine is for example Urapidil.
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