Subarachnoid hemorrhage natural history, complications and prognosis: Difference between revisions
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==Natural history== | ==Natural history== | ||
Following rupture of an aneurysm, the blood directly release into the [[cerebrospinal fluid|cerebrospinal fluid (CSF]]) under [[arterial pressure]]. As the blood spreads quickly into the CSF, it rapidly increasing [[intracranial pressure]].<ref name="pmid23289820">{{cite journal| author=Schuss P, Konczalla J, Platz J, Vatter H, Seifert V, Güresir E| title=Aneurysm-related subarachnoid hemorrhage and acute subdural hematoma: single-center series and systematic review. | journal=J Neurosurg | year= 2013 | volume= 118 | issue= 5 | pages= 984-90 | pmid=23289820 | doi=10.3171/2012.11.JNS121435 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23289820 }} </ref> | Following rupture of an [[aneurysm]], the blood directly release into the [[cerebrospinal fluid|cerebrospinal fluid (CSF]]) under [[arterial pressure]]. As the blood spreads quickly into the [[CSF]], it rapidly increasing [[intracranial pressure]].<ref name="pmid23289820">{{cite journal| author=Schuss P, Konczalla J, Platz J, Vatter H, Seifert V, Güresir E| title=Aneurysm-related subarachnoid hemorrhage and acute subdural hematoma: single-center series and systematic review. | journal=J Neurosurg | year= 2013 | volume= 118 | issue= 5 | pages= 984-90 | pmid=23289820 | doi=10.3171/2012.11.JNS121435 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23289820 }} </ref> | ||
Depending on the location of the | |||
*Intraventricular space | Depending on the location of the [[aneurysm]], the blood can spread into: | ||
*Brain parenchyma | *[[Intraventricular|Intraventricular space]] | ||
*Subdural space | *Brain parenchyma | ||
*[[Subdural space]] | |||
The bleeding usually lasts only a few seconds. However, rebleeding can be considered as one of the complication which can occur within the first day.<ref name="pmid23117495">{{cite journal| author=Biesbroek JM, van der Sprenkel JW, Algra A, Rinkel GJ| title=Prognosis of acute subdural haematoma from intracranial aneurysm rupture. | journal=J Neurol Neurosurg Psychiatry | year= 2013 | volume= 84 | issue= 3 | pages= 254-7 | pmid=23117495 | doi=10.1136/jnnp-2011-302139 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23117495 }} </ref> | The bleeding usually lasts only a few seconds. However, rebleeding can be considered as one of the complication which can occur within the first day.<ref name="pmid23117495">{{cite journal| author=Biesbroek JM, van der Sprenkel JW, Algra A, Rinkel GJ| title=Prognosis of acute subdural haematoma from intracranial aneurysm rupture. | journal=J Neurol Neurosurg Psychiatry | year= 2013 | volume= 84 | issue= 3 | pages= 254-7 | pmid=23117495 | doi=10.1136/jnnp-2011-302139 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23117495 }} </ref> | ||
==Complications== | ==Complications== |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Sara Mehrsefat, M.D. [3]
Natural history
Following rupture of an aneurysm, the blood directly release into the cerebrospinal fluid (CSF) under arterial pressure. As the blood spreads quickly into the CSF, it rapidly increasing intracranial pressure.[1]
Depending on the location of the aneurysm, the blood can spread into:
- Intraventricular space
- Brain parenchyma
- Subdural space
The bleeding usually lasts only a few seconds. However, rebleeding can be considered as one of the complication which can occur within the first day.[2]
Complications
Complications of SAH can be acute, subacute, or chronic.
- Acute:
- Coma and brainstem herniation due to increased intracranial pressure (ICP)
- Pulmonary edema ("neurogenic pulmonary edema") as a result of the suddenly increased ICP
- Cardiac arrhythmias and myocardial damage
- Hydrocephalus, which may also happen in the subacute time frame
- Subacute:
- Vasospasm, leading to ischemia of the brain
- Hyponatremia (low sodium levels) - due to SIADH or cerebral salt wasting syndrome
- Chronic:
- Long-term immobility
- Pneumonia and pulmonary embolism (due to immobility)
- SAH recurrence (20% within two weeks if the aneurysm is not secured by clipping or coiling)
- Persistent neurologic deficits
Prognosis
Nearly half the cases of SAH are either dead or moribund before they reach a hospital. Of the remainder, a further 10-20% die in the early weeks in hospital from rebleeding. Delay in diagnosis of minor SAH without coma (or mistaking the sudden headache for migraine) contributes to this mortality. Patients who remain comatose or with persistent severe deficits have a poor prognosis.[2]
After the SAH is treated the patients can experience prolonged, even permanently reoccurring headaches.
References
- ↑ Schuss P, Konczalla J, Platz J, Vatter H, Seifert V, Güresir E (2013). "Aneurysm-related subarachnoid hemorrhage and acute subdural hematoma: single-center series and systematic review". J Neurosurg. 118 (5): 984–90. doi:10.3171/2012.11.JNS121435. PMID 23289820.
- ↑ 2.0 2.1 Biesbroek JM, van der Sprenkel JW, Algra A, Rinkel GJ (2013). "Prognosis of acute subdural haematoma from intracranial aneurysm rupture". J Neurol Neurosurg Psychiatry. 84 (3): 254–7. doi:10.1136/jnnp-2011-302139. PMID 23117495.