Subarachnoid haemorrhage may occur as a consequence of a head injury, but it may also be caused by a rupture of an aneurysm of one of the intracranial vessels. The most characteristic symptom of this problem is the extreme nature of the headache - patients who experience subarachnoid hemorrhage usually describe it as the strongest headache they have ever experienced in their life. Unfortunately, the prognosis of patients who develop this problem is not favorable.

Subarachnoid hemorrhage(SAH for short) is associated with the accumulation of blood between the arachnoid and dura mater of the brain and is one of the possible causes of stroke - estimated it is responsible for 5% of all these conditions. This disease has been known to medicine for quite a long time, because it has been suggested that the clinical picture of subarachnoid bleeding was already described by Hippocrates, but more information about this problem was obtained only from the 18th century, when the medical world first learned about the possibility of aneurysms in humans and that these structures can break.

Statistically, one in ten thousand people has a subarachnoid hemorrhage each year. More cases of this problem are noted in women. In general, the risk of subarachnoid bleeding increases with age, but it is noticeable that up to half of this type of hemorrhage is found in people under 55 years of age.

Theoretically, it would seem that subarachnoid hemorrhages - due to the fact that problems such as ischemic stroke or hemorrhagic stroke occur much more often - are not worth paying much attention to. However, when you take into account that in Poland every year up to 3,000 patients experience this problem and how serious the effects of subarachnoid hemorrhage can be, then it becomes clearly noticeable how important this disease is and that it is definitely worth talking about.

Subarachnoid hemorrhage: causes

A large proportion of subarachnoid hemorrhages are caused by experiencing a head injury. However, this is not the only possible cause of subarachnoid haemorrhage - it also happens that the haemorrhage occurs spontaneously in the patient and in such a situation the most common source ofthe problem is an intracranial aneurysm rupture. Changes of this type are most often located within the arterial system, which are part of the so-called arterial wheel of the brain (Willis wheel). Subarachnoid haemorrhage is also more common in people who:

  • have some intracranial arteriovenous malformations
  • taking cocaine
  • suffer from sickle cell anemia

Subarachnoid haemorrhage: risk factors

In addition to the above-mentioned problems, there are also several other risk factors that increase the possibility of subarachnoid bleeding in the patient. They include:

  • hypertension (especially uncontrolled, i.e. improperly treated)
  • smoking
  • alcohol abuse

An increased risk of subarachnoid hemorrhage is also experienced by those people whose relatives have experienced such a problem in their lives.

Subarachnoid hemorrhage: symptoms

The most characteristic symptom of subarachnoid hemorrhage is headache. It should be emphasized here, however, that this pain is special - patients usually say that it is piercing, but it is even more noticeable that patients describe it as the strongest headache they have ever experienced. However, this is not the only symptom of subarachnoid hemorrhage - among other ailments that may appear in its course, the following are listed:

  • severe nausea and vomiting
  • convulsions
  • speech disorders (e.g. in the form of slurred speech)
  • disturbance of consciousness
  • intraocular haemorrhage
  • sudden increase in blood pressure

As time passes from the onset of subarachnoid hemorrhage, patients may experience other ailments. It is possible to develop a stiff neck (this typically develops 6 hours after the start of bleeding). It happens that in the course of haemorrhage, some cranial nerves are paralyzed, which may be manifested, among others, by double vision or drooping eyelid. There is also a possibility of various types of paralysis in the course of subarachnoid hemorrhage.

Subarachnoid haemorrhage: diagnosis

In particular, a subarachnoid haemorrhage should be suspected in people who complain of a headache of exceptional intensity and have never experienced such ailments before. Here, however, it should be immediately clarified that the diagnosis of bleeding into the space between the spider mite andsoft is not impossible in people who often struggle with headaches (such as migraines) - in such a situation patients usually say that the pain they feel is definitely different from the "typical" headaches.

The patient is initially subjected to a physical examination, which may detect bleeding abnormalities, such as, for example, neck stiffness (if this has developed), and always assess the patient's awareness (usually using the Glasgow Coma Scale). ).

If the abnormalities found during the initial assessment of the patient's condition suggest a subarachnoid hemorrhage, it becomes necessary to order appropriate tests. Usually, the first computed tomography of the head is performed without contrast - during the first six hours from the beginning of bleeding, it is possible to diagnose even more than 98% of all cases of this problem.

If there are any doubts, a lumbar puncture may be performed - the detection of blood in the cerebrospinal fluid, along with other symptoms of subarachnoid hemorrhage, may confirm this diagnosis.

Among other tests, which are also performed when bleeding into the space between the soft dura and the spider web is suspected, there are e.g. Magnetic resonance angiography and invasive angiography.

It should also be mentioned that - due to the fact that subarachnoid hemorrhages are not really common - other conditions are also taken into account that may be responsible for the patient's ailments. In this case, the differential diagnosis mainly includes migraine, tension headaches, thrombosis of the venous sinuses of the brain and meningitis.

Subarachnoid haemorrhage: complications

A particular possible complication of a subarachnoid haemorrhage that definitely deserves more attention is the risk of developing a vascular spasm. This problem may be exacerbated by the bleeding disorders, if it occurs, usually after the third day from the start of the haemorrhage, and it is most severe between the 5th and 7th day after its onset.

There are several theories about the pathomechanism of vascular contraction. It takes into account the release of calcium from inside the cells, leading to contraction of muscle cells in the blood vessels, but also various other processes, such as e.g. the appearance of increased amounts of free radicals, endothelins and prostaglandins in the structures of the central nervous system.

FollowingSubarachnoid haemorrhage, vasoconstriction is certainly not a favorable phenomenon - it limits the blood supply to nerve cells, exacerbating the damage that occurs due to bleeding. It is for this reason that attempts are made to prevent subarachnoid hemorrhage during the treatment of subarachnoid hemorrhage.

Subarachnoid hemorrhage: treatment

Initially, in the treatment of subarachnoid hemorrhage, the most important thing is to stabilize the patient's condition - with significant disturbances of consciousness, it may be necessary, among others, to be intubation and the use of artificial ventilation. In such a case, constant monitoring of the patient is required, e.g. his blood pressure, pulse and respiration rate.

If the patient's condition allows it, appropriate procedures are performed - they are especially important in patients whose subarachnoid hemorrhage resulted from an intracranial aneurysm rupture.

An example of an operation that can be performed in such a situation is endovascular embolization of the aneurysm, sometimes clipping of ruptured aneurysms is also performed using the open method.

It is extremely important in the treatment of subarachnoid haemorrhage to prevent re-bleeding. For this purpose, first of all, antihypertensive drugs are used, which allow to maintain arterial pressure within the desired limits (usually it is assumed that the systolic pressure should be between 140 and 160 mmHg).

Drugs that can be used in such a situation are, among others labetalol and nicardipine. After subarachnoid hemorrhage, patients may be administered another drug - nimodipine - whose task is to reduce the risk of vasoconstriction. Relief of pain also plays an important role (for this purpose, e.g. opioid analgesics can be used).

Subarachnoid haemorrhage: prognosis

Unfortunately, the prognosis of patients who develop subarachnoid hemorrhage is not favorable. Even before reaching the hospital, 10-15% of patients die. The remaining patients - hospitalized persons - in 40% experience death within one month of bleeding.

Among those who survive, most often there are various neurological deficits, such as, for example, gait disturbances or balance disorders, but also other problems, such as mood disorders.

The best prognosis is for those patients who have a minor bleeding and who do not develop any complications (such as the vascular spasm described previously).

Subarachnoid hemorrhage: prevention

Subarachnoid hemorrhage cannot be completely prevented, but its risk can be limited. It can be said that the prevention of bleeding is based on maintaining appropriate blood pressure values, avoiding excessive alcohol consumption or smoking, and regular physical activity - in short, it can be assumed that the risk can be reduced by leading a generally understood he althy lifestyle.

There may be a thought that theoretically, the risk of subarachnoid hemorrhage could be reduced by regular imaging of the head, which would allow the diagnosis of intracerebral aneurysms in patients. However, such an approach - due to the fact that these changes are rarely seen in humans - is not considered justified.

Tests aimed at detecting possible aneurysms - if at all - can be considered in people who suffer from some diseases in the course of which there is a definitely increased tendency to their occurrence. An example of such a disease is inherited autosomal dominant polycystic kidney disease (ADPKD).

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

Category:

Cardiology