Subarachnoid hemorrhage history and symptoms: Difference between revisions

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*Sudden or decreased consciousness  
*Sudden or decreased consciousness  
*Weakness on one side of the body
*Weakness on one side of the body
==History and symptoms==
===History===
It is critical to obtain a detailed and focused history.<ref name=Huhtakangas>Huhtakangas J, Tetri S, Juvela S, Saloheimo P, Bode MK, Hillbom M. Effect of increased warfarin use on warfarin-related cerebral hemor- rhage: a longitudinal population-based study. Stroke. 2011;42:2431– 2435. doi: 10.1161/STROKEAHA.111.615260.</ref><ref name=Rådberg> Rådberg JA, Olsson JE, Rådberg CT. Prognostic parameters in sponta- neous intracerebral hematomas with special reference to anticoagulant treatment. Stroke. 1991;22:571–576. doi: 10.1161/01.STR.22.5.571.</ref><ref name=Flaherty> Flaherty ML, Kissela B, Woo D, Kleindorfer D, Alwell K, Sekar P, Moomaw CJ, Haverbusch M, Broderick JP. The increasing incidence of anticoagulant-associated intracerebral hemorrhage. Neurology. 2007;68:116–121. doi: 10.1212/01.wnl.0000250340.05202.8b.</ref><ref name="pmid12843354">{{cite journal| author=Ariesen MJ, Claus SP, Rinkel GJ, Algra A| title=Risk factors for intracerebral hemorrhage in the general population: a systematic review. | journal=Stroke | year= 2003 | volume= 34 | issue= 8 | pages= 2060-5 | pmid=12843354 | doi=10.1161/01.STR.0000080678.09344.8D | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12843354  }} </ref><ref name="pmid17962600">{{cite journal| author=Bos MJ, Koudstaal PJ, Hofman A, Breteler MM| title=Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam Study. | journal=Stroke | year= 2007 | volume= 38 | issue= 12 | pages= 3127-32 | pmid=17962600 | doi=10.1161/STROKEAHA.107.489807 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17962600  }} </ref><ref name="pmid23077009">{{cite journal| author=Hackam DG, Mrkobrada M| title=Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis. | journal=Neurology | year= 2012 | volume= 79 | issue= 18 | pages= 1862-5 | pmid=23077009 | doi=10.1212/WNL.0b013e318271f848 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23077009  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23449782 Review in: Evid Based Ment Health. 2013 May;16(2):54] </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 220px;" | {{fontcolor|#FFF|History}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Comments}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Timing of the symptoms onset'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*The time the patient was last normal
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Initial symptoms'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*The progression of symptoms
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Vascular risk factors'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Hypertension]]
*[[Diabetes]]
*[[Hypercholesterolemia]]
*[[Smoking]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Medications'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Anticoagulants]]
*[[Antiplatelet agents]]
*[[Decongestants]]
*Antihypertensive medications
*[[Stimulants]] (including diet pills)
*[[Sympathomimetics]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Recent trauma or surgery'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*ICH may be related to hyperperfusion after
**[[endarterectomy |Carotid endarterectomy]]
**[[stenting |Carotid stenting]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Dementia'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Associated with [[amyloid|amyloid angiopathy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Alcohol or illicit drug use'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Cocaine]]
*Other sympathomimetic drugs
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Liver disease
| style="padding: 5px 5px; background: #F5F5F5;" |
*Associated with [[coagulopathy]]
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cancer and hematologic disorders
| style="padding: 5px 5px; background: #F5F5F5;" |
*Associated with [[coagulopathy]]
|}
===Symtoms===
It is impossible to know whether symptoms are due to ischemia or hemorrhage based on clinical characteristics alone. The abrupt onset of focal neurologic symptoms is presumed to be vascular in origin.
Non specific symptoms of hemorrhagic stroke may include the following:<ref name="pmid11346811">{{cite journal| author=Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF| title=Spontaneous intracerebral hemorrhage. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 19 | pages= 1450-60 | pmid=11346811 | doi=10.1056/NEJM200105103441907 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11346811  }} </ref><ref name="pmid4105427">{{cite journal| author=Fisher CM| title=Pathological observations in hypertensive cerebral hemorrhage. | journal=J Neuropathol Exp Neurol | year= 1971 | volume= 30 | issue= 3 | pages= 536-50 | pmid=4105427 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4105427  }} </ref>
*[[Vomiting]]
*[[Systolic blood pressure]] >220 mm Hg
*[[headache|Severe headache]]
*[[loss of consciousness|Decreased level of consciousness]]
*Rapid progression of symptoms


==References==
==References==

Revision as of 18:14, 8 December 2016

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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]

Overview

The classic symptom of subarachnoid hemorrhage is thunderclap headache ("most severe ever" headache developing over seconds to minutes). This headache is often described like being "kicked in the head".[1] 10% of all people with this symptom turn out to have a subarachnoid hemorrhage, and is the only symptom in about a third of all SAH patients. Other presenting features may be vomiting (non-specific), seizures (1 in 14) and meningism. Confusion, decreased level of consciousness or coma may be present. Intraocular hemorrhage (bleeding into the eyeball) may occur. Subhyaloid hemorrhages may be visible on fundoscopy (the hyaloid membrane envelopes the vitreous body).

History and Symptoms

History and symptoms

History

It is critical to obtain a detailed and focused history.[2][3][4][5][6][7]

History Comments
Timing of the symptoms onset
  • The time the patient was last normal
Initial symptoms
  • The progression of symptoms
Vascular risk factors
Medications
Recent trauma or surgery
Dementia
Alcohol or illicit drug use
  • Cocaine
  • Other sympathomimetic drugs
Liver disease
Cancer and hematologic disorders

Symtoms

It is impossible to know whether symptoms are due to ischemia or hemorrhage based on clinical characteristics alone. The abrupt onset of focal neurologic symptoms is presumed to be vascular in origin.

Non specific symptoms of hemorrhagic stroke may include the following:[8][9]

References

  1. ↑ Longmore, Murray (2007). Oxford Handbook of Clinicial Medicine. Oxford. p. 841. ISBN 0-19-856837-1. Unknown parameter |coauthors= ignored (help)
  2. ↑ Huhtakangas J, Tetri S, Juvela S, Saloheimo P, Bode MK, Hillbom M. Effect of increased warfarin use on warfarin-related cerebral hemor- rhage: a longitudinal population-based study. Stroke. 2011;42:2431– 2435. doi: 10.1161/STROKEAHA.111.615260.
  3. ↑ Rådberg JA, Olsson JE, Rådberg CT. Prognostic parameters in sponta- neous intracerebral hematomas with special reference to anticoagulant treatment. Stroke. 1991;22:571–576. doi: 10.1161/01.STR.22.5.571.
  4. ↑ Flaherty ML, Kissela B, Woo D, Kleindorfer D, Alwell K, Sekar P, Moomaw CJ, Haverbusch M, Broderick JP. The increasing incidence of anticoagulant-associated intracerebral hemorrhage. Neurology. 2007;68:116–121. doi: 10.1212/01.wnl.0000250340.05202.8b.
  5. ↑ Ariesen MJ, Claus SP, Rinkel GJ, Algra A (2003). "Risk factors for intracerebral hemorrhage in the general population: a systematic review". Stroke. 34 (8): 2060–5. doi:10.1161/01.STR.0000080678.09344.8D. PMID 12843354.
  6. ↑ Bos MJ, Koudstaal PJ, Hofman A, Breteler MM (2007). "Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam Study". Stroke. 38 (12): 3127–32. doi:10.1161/STROKEAHA.107.489807. PMID 17962600.
  7. ↑ Hackam DG, Mrkobrada M (2012). "Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis". Neurology. 79 (18): 1862–5. doi:10.1212/WNL.0b013e318271f848. PMID 23077009. Review in: Evid Based Ment Health. 2013 May;16(2):54
  8. ↑ Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001). "Spontaneous intracerebral hemorrhage". N Engl J Med. 344 (19): 1450–60. doi:10.1056/NEJM200105103441907. PMID 11346811.
  9. ↑ Fisher CM (1971). "Pathological observations in hypertensive cerebral hemorrhage". J Neuropathol Exp Neurol. 30 (3): 536–50. PMID 4105427.

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