Subarachnoid hemorrhage pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Pathophysiology

Aneurysmal subarachnoid hemorrhage

Saccular aneurysms are responsible for most SAHs, although fusiform and mycotic aneurysms can also result in suarachnoid hemorrhage It is thought that the formation of saccular aneurysm is multifactorial. It usually result from degenerative change in the vessel wall following:

• Hemodynamic stress (turbulent blood flow) may result in excessive tear and breakdown of the internal elastic lamina which it progress to lack of elastic lamina and

Common associated conditions may include:

• Hypertension
• Cigarette smoking
• Connective tissue disease

It is also thought that inflammatory process is also play a role in pathogenesis of aneurysms

=Histopathologic findings

Histological types	Consecutive stages of aneurysm walls	Chance of aneurysmal rupture
Type A	Endothelialized wall Linearly organized smooth muscle cell	41%
Type B	Thickened wall Disorganized smooth muscle cells	55%
Type C	Hypocellular wall Either intimal hyperplasia or organizing luminal thrombosis	64%
Type D	Extremely thin thrombosis-lined hypocellular wall	100%