Subarachnoid Hemorrhage (SAH) Ionuţ Cărăvan Coordinated by Prof. Ioan Ştefan Florian, MD, PhD University of Medicine and Pharmacy “Iuliu Haţieganu“ Cluj Napoca
Dec 17, 2014
Subarachnoid Hemorrhage(SAH)
Ionuţ Cărăvan Coordinated by Prof. Ioan Ştefan Florian, MD, PhD
University of Medicine and Pharmacy “Iuliu Haţieganu“ Cluj Napoca
Definition
• SAH = extravasation of blood into the subarachnoid space
Etiology
Greenberg Handbook of Neurosurgery, 2010
Traumatic SAH Non-traumatic (spontaneous) SAH
o ruptured intracranial aneurysms (75 %)oAVM (5 %)oothers (tumor, vasculitis, coagulation disorders, dural
sinus thrombosis)ounknown etiology (15 %)=“angiogram-negative SAH”
Presenting features(1)
• HEADACHE (“thunderclap headache”)• meningismus
neck stiffness photophobia back pain
Presenting features(2)
• decreased state of consciousness• nausea and vomiting• seizures• focal neurologic deficits:
oculomotor palsy hemiparesis
• ocular hemorrhage
Radiographic findings
• CT scan• Cerebral Angiography• FLAIR* MRI• CT Angiography• MRA**
*Fluid-attenuated inversion recovery**Magnetic Resonance Angiography
CT scan
Lumbar puncture
Grading SAH
Hunt and Hess Grade WFNS* Grading
*World Federation of Neurological Surgeons
Complications
• Hydrocephalus• Vasospasm => delayed cerebral ischemia • Seizures• Rebleeding• Intracerebral hemorrhage• Intraventricular hemorrhage• Left ventricular systolic dysfunction• Subdural hematoma
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
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.
Thank you!