Subarachnoid haemorrhage

Subarachnoid hemorrhage is considered a clinical syndrome. This manifestation differs nosological independence and is due to various factors. Subarachnoid hemorrhage of a nontraumatic nature is considered spontaneous and refers to a variety of hemorrhagic stroke.

Most often, the syndrome is triggered by a rupture of the vascular aneurysm. As a rule, there are aneurysms in the base of the brain on the site of arterial branching.

The risk factors that cause subarachnoid hemorrhage include arterial hypertension, especially accompanied by daily fluctuations in blood pressure, smoking, taking oral contraceptives, alcoholism, and cocaine use. During the prenatal period and during childbirth, there is often a likelihood of developing this clinical syndrome. It should be noted that close relatives of patients who are diagnosed with subarachnoid hemorrhage are also often prone to aneurysms.

The treatment of an aneurysm without rupture is advisable at a size of more than seven millimeters, with a clinical syndrome in the anamnesis, as well as in the presence of symptomatic aneurysms and other risk factors.

If two cases of subarachnoid hemorrhage are detected in the same family in the same family, the members should conduct an MR-angiography as a screening.

The most common spontaneous causes of this syndrome, not associated with aneurysms, include small ruptures in the intradural arteries, mycotic aneurysms, immunodeficiency or drug-related arteritis. As practice shows, the frequency of recurrent cases is one percent per year.

Subarachnoid hemorrhage in the brain is diagnosed with the manifestation of distinctive clinical signs. Confirmation of the diagnosis is carried out with the help of CT. If a CT scan is not possible or the study does not work, a lumbar puncture (LP) is prescribed.

Subarachnoid hemorrhage. Symptoms

The most characteristic manifestations of the syndrome include a sudden headache that developed or developed within a few seconds or minutes. In most cases, patients compare it with a sharp blow to the head. After a few seconds, in about half the cases, the patients lose consciousness, which spontaneously recovers in most cases. The clinical picture can be compared with the syncopal condition or epileptic seizure. It should be noted that epileptic seizure in many cases develops with subarachnoid hemorrhage, and in some patients there is a manifestation of neurogenic disorders of the heart rhythm. Localization of an aneurysm may be reflected by an easy or moderate focal neurological deficit. After several hours after subarachnoid hemorrhage, in many cases stiffness in the occipital muscles is manifested.

In mild cases, patients may feel nausea, neck pain, which is sometimes misdiagnosed as cervical osteochondrosis. The occurrence of sudden pain between the shoulder blades or in the lower part of the neck indicates a spinal hemorrhage.

The diagnosis must be differentiated with cerebral thrombosis of veins, meningoencephalitis, migraine, sinusitis, acute hypertensive encephalopathy .

The blood present in the subarachnoid space can not be detected with CT after the day, after five days it is not detected in half of the cases.

Confirmation of the diagnosis and suspicion of the connection of subarachnoid hemorrhage with an aneurysm presumes the use of cerebral angiography and hospitalization in the neurosurgical department when an aneurysm is detected. If in the detection of severe headaches, LP and CT produced in the first two weeks of the disease are absolutely normal, cerebral hagiography is not prescribed.