Subarachnoid haemorrhage defined as a sudden bleeding into the subarachnoid space. The most common cause of spontaneous bleeding is a ruptured aneurysm. Symptoms include sudden, severe headache, usually with loss of consciousness or disorder of consciousness. Secondary vasospasm (which cause focal brain ischemia), neck stiffness and hydrocephalus (the persistent headache and dizziness caused) are common. The diagnosis is made using a CT scan or MRI, in unaffected neuroradiological imaging by CSF analysis. The treatment is carried out with supportive, neuro surgical or endovascular means, preferably in a comprehensive stroke center.

Subarachnoid haemorrhage defined as a sudden bleeding into the subarachnoid space. The most common cause of spontaneous bleeding is a ruptured aneurysm. Symptoms include sudden, severe headache, usually with loss of consciousness or disorder of consciousness. Secondary vasospasm (which cause focal brain ischemia), neck stiffness and hydrocephalus (the persistent headache and dizziness caused) are common. The diagnosis is made using a CT scan or MRI, in unaffected neuroradiological imaging by CSF analysis. The treatment is carried out with supportive, neuro surgical or endovascular means, preferably in a comprehensive stroke center. Etiology Subarachnoid haemorrhage is bleeding between the arachnoid and pia mater. Generally speaking, a head trauma is the most common cause of traumatic subarachnoid hemorrhage but are usually as a separate disorder image viewed (s. Traumatic brain injury (TBI)). Spontaneous (primary) subarachnoid hemorrhage are usually due to ruptured aneurysms. An innate intracranial aneurysm sack or beer-like is the cause of approximately 85% of patients. The bleeding may stop spontaneously. Aneurysmal hemorrhage can occur at any age but is most common between the ages of 40 and 65. Less common causes are mycotic aneurysms, arteriovenous malformations and bleeding abnormalities. Pathophysiology of blood in the subarachnoid space causes a chemical meningitis, which usually increases the intracranial pressure over days or a few weeks. Secondary vasospasm can cause focal Hirnisch√§mien; approximately 25% of patients develop signs of a transient ischemic attack (TIA) or ischemic stroke. Between day 3 and day 10, the cerebral edema is most pronounced and the risk of vasospasm and subsequent infarction ( “angry brain”) is the largest. A secondary acute hydrocephalus is also common. A second rupture with bleeding may occur, usually within 7 days. Symptoms and complaints The headache in the form of an extermination pain usually occurs within seconds. A loss of consciousness can, mostly immediately connect, but sometimes follow after a few hours. Severe neurological deficits can develop and become irreversible within minutes or a few hours. The mind can be disturbed, and patients may be uneasy. Insults are possible. Usually, initially no neck stiffness, unless the cerebellar tonsils pinch. Within 24 hours, however, caused the chemical meningitis a moderate to significant neck stiffness, vomiting and sometimes a mutually positive Babinski sign. The pulse or respiration rate are often abnormal. Fever, chronic headache and confusion are common within the first 5-10 days. A secondary hydrocephalus can cause headache, dizziness and motor deficits that persist for weeks. A renewed bleeding may lead to recurrence of symptoms or new symptoms. Diagnosis usually unenhanced CT and a negative result, lumbar puncture The diagnosis is probably by characteristic symptoms. An investigation should be carried out as quickly as possible, before the damage is irreversible. Unenhanced CT is> 90% sensitive and is particularly sensitive when it is performed within 6 hours after symptom onset. An MRI is relatively sensitive but available less likely immediately. False-negative results occur when only a small volume of blood has leaked, or if the patient is so anemic that the blood the same manner to the brain tissue. If clinically subarachnoid hemorrhage is suspected, but this can not be identified with the neuro-radiological imaging or neuroradiological recording is not immediately available, a lumbar puncture is performed (lumbar puncture (spinal tap)). The lumbar puncture is contraindicated in suspected. increased intracranial pressure because the abrupt pressure relief in the liquor reduces the tamponade by extravasated blood to the aneurysm, thus causing further bleeding. Tips and risks A subarachnoid hemorrhage should be suspected if headache reach the top, it comes within seconds of the start of a severe intensity or causing loss of consciousness. If a CT scan shows no bleeding or is not available, perform a lumbar puncture. Subarachnoid hemorrhage With permission of the publisher. From Lenaerts M., J. Couch In Atlas of Clinical Neurology. Edited by R. N. Rosenberg. Philadelphia, Current Medicine, 2002. var model = {thumbnailUrl: ‘/-/media/manual/professional/images/subarachnoid_hemorrhage_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/ – / media / manual / professional / images / subarachnoid_hemorrhage_high_de.jpg lang = en & thn = 0 ‘, title:’? subarachnoid hemorrhage ‘description:’ u003Ca id = “v38396814 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eDie CT scan of a patient with subarachnoid hemorrhage shows blood in the sulci (arrow). Often blood can be seen in the ventricles u003c / p u003e u003c / div u003e ‘credits’. With permission of the publisher. From Lenaerts M.

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