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Subarachnoid HemorrhageAka: Intracranial Hemorrhage, SAH

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  1. See Also
    1. Cerebral Aneurysm
    2. Neurovascular Anatomy
  2. Symptoms
    1. Sudden onset of "Worst Headache of my life"
    2. "Thunder-Clap" Headache
    3. Headache reaches maximum intensity in minutes
    4. Continued unrelenting Headache
    5. May be accompanied by Nausea and Vomiting
    6. Initial herald bleed (sentinel hemorrhage)
      1. Warning leak of small volume
      2. May precede full aneurysm rupture in >50% of cases
  3. Signs
    1. Identify subtle focal neurologic changes
      1. Anterior Cerebral Artery CVA
      2. Middle Cerebral Artery CVA
      3. Vertebro-Basilar CVA
      4. Posterior Cerebral Artery CVA
      5. Posterior Inferior Cerebellar Artery CVA
    2. Brief Loss of consciousness at Headache onset
    3. Meningismus (e.g. Nuchal Rigidity)
    4. Ocular motor nerve palsy
    5. Papilledema
  4. Course
    1. Missed Subarachnoid Hemorrhage
      1. Rebleeding risk: 50% in 2 weeks
      2. Increased mortality risk
  5. Diagnosis
    1. CT Head without contrast (misses 5% of SAH)
      1. Day 3: 95% sensitivity
      2. Day 5: 85% sensitivity
      3. Day 7: 50% sensitivity
      4. Day 14: 30% sensitivity
    2. Lumbar Puncture
      1. Indicated for high suspicion but negative CT Head
      2. CSF RBCs: 1000-2000 within 2-12 hours after Headache
      3. CSF Leukocytes and protein may also be increased
      4. Xanthochromia in centrifuged Cerebrospinal fluid
  6. Management
    1. Neurosurgery Consultation
      1. Endovascular coiling may be preferred over surgery
        1. Higher one year survival: 23.7% versus 30.6%
        2. Shorter delay to procedure: 1.1 versus 1.7 days
        3. (2002) Lancet 360:1267
    2. Head of Bed at 30 degrees
    3. Prevent vasospasm with good hydration
    4. Use Nipride to keep Systolic Blood Pressure <130 mmHg
    5. Dilantin for Seizure Prophylaxis
    6. Minimize cough with codeine
    7. Minimize Pain with Morphine
    8. Minimize Constipation
    9. If High Intracerebral Pressure or "Blown Pupil"
      1. Titrate Mannitol (start at 1 gram/kg)
        1. Check Serum Osmolality (keep 305-315)
        2. Check Serum Sodium q6h (keep >140)
      2. Hyperventilate to PCO2 of 30-35 mmHg

Subarachnoid Hemorrhage (C0038525)

Definition (MSH)Bleeding into the intracranial or spinal SUBARACHNOID SPACE, most resulting from INTRACRANIAL ANEURYSM rupture. It can occur after traumatic injuries (SUBARACHNOID HEMORRHAGE, TRAUMATIC). Clinical features include HEADACHE; NAUSEA; VOMITING, nuchal rigidity, variable neurological deficits and reduced mental status.
Definition (NCI)Intracranial hemorrhage into the subarachnoid space.
Definition (NCI)Intracranial hemorrhage into the subarachnoid space.
Definition (CSP)hemorrhage within the intracranial or spinal subarachnoid space.
ConceptsDisease or Syndrome (T047)
ICD9430
MSHD013345
EnglishHEMORRHAGE SUBARACHNOID, SAH - Subarachnoid haemorrhage, SAH - Subarachnoid hemorrhage, SUBARACHNOID HAEMORRHAGE, SUBARACHNOID HEMORRHAGE, Subarachnoid Hemorrhages
Spanishhemorragia subaracnoidea
Parent ConceptsCerebral hemisphere hemorrhage (C0007784), Hemorrhage (C0019080), Meningeal disorder (C0154728), Vascular Disorders, General and NEC (C0549519), VASCULAR: INTRACRANIAL (C0549642), Cerebrovascular Disorders (C0007820), Intracranial Hemorrhages (C0151699), Subarachnoid Hemorrhage (C0038525), Duplicate concept (C1274013)
SourcesCOSTAR, CSP, CST, DXP, ICD9CM, LCH, MSH, MTH, NCI, NDFRT, OMIM, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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