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Subarachnoid Hemorrhage

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Presented at the Second Neurosurgical MasterClass, Cluj-Napoca, 2014.

Published in: Health & Medicine, Technology
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Subarachnoid Hemorrhage

  1. 1. Subarachnoid Hemorrhage (SAH) Ionuţ Cărăvan Coordinated by Prof. Ioan Ştefan Florian, MD, PhD University of Medicine and Pharmacy “Iuliu Haţieganu“ Cluj Napoca
  2. 2. Definition • SAH = extravasation of blood into the subarachnoid space
  3. 3. Etiology Greenberg Handbook of Neurosurgery, 2010  Traumatic SAH  Non-traumatic (spontaneous) SAH oruptured intracranial aneurysms (75 %) oAVM (5 %) oothers (tumor, vasculitis, coagulation disorders, dural sinus thrombosis) ounknown etiology (15 %)=“angiogram-negative SAH”
  4. 4. Presenting features(1) • HEADACHE (“thunderclap headache”) • meningismus  neck stiffness  photophobia  back pain
  5. 5. Presenting features(2) • decreased state of consciousness • nausea and vomiting • seizures • focal neurologic deficits:  oculomotor palsy  hemiparesis • ocular hemorrhage
  6. 6. Radiographic findings • CT scan • Cerebral Angiography • FLAIR* MRI • CT Angiography • MRA** *Fluid-attenuated inversion recovery **Magnetic Resonance Angiography
  7. 7. CT scan
  8. 8. Lumbar puncture
  9. 9. Grading SAH Hunt and Hess Grade WFNS* Grading *World Federation of Neurological Surgeons
  10. 10. Complications • Hydrocephalus • Vasospasm => delayed cerebral ischemia • Seizures • Rebleeding • Intracerebral hemorrhage • Intraventricular hemorrhage • Left ventricular systolic dysfunction • Subdural hematoma
  11. 11. Treatment • BP control (fluid restriction and antihypertensive therapy) when the mean arterial pressure exceeds 130 mm Hg • ICP control (osmotic agents, loop diuretics) • Symptomatic treatment: – anticonvulsants: levetiracetam, phenytoin – analgesics: fentanyl – anti-emetics: odansetron – calcium channel blockers: nimodipine, verapamil => vasospasm !!! Prevention of rebleeding: • antifibrinolytic therapy • surgical treatment • endovascular treatment
  12. 12. References • MS Greenberg. Handbook of Neurosurgery. Seventh Edition. New York: Thieme Medical Publishers; 2010. • AH Kaye. Essential Neurosurgery. Third Edition. Oxford: Blackwell Publishing Ltd; 2005. • MG Yasargil. Microneurosurgery. New York: Thieme Medical Publishers Inc; 1994.
  13. 13. Thank you!

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