II. Background
- See Subarachnoid Hemorrhage
- This page refers only to Traumatic Subarachnoid Hemorrhage (non-aneurysmal)
III. Mechanism
- See Head Injury
- Fall with Head Injury in the elderly
- Motor Vehicle Accident in younger patients
IV. Imaging
V. Management: General
VI. Management: Small Traumatic Subarachnoid Hemorrhage
- Background
- Small Traumatic Subarachnoid Hemorrhage (SAH) is a common finding on CT Head after Closed Head Injury
- Unlike Aneurysmal SAH, small Traumatic SAH is much less likely to have neurologic decompensation
- Cerebral Vasoconstriction is much less likely in Traumatic SAH (contrast with Aneurysmal SAH)
- Monitoring
- Serial Neurologic Exams
- Repeat CT Head in 6 hours after first imaging CT Head
- Indicated for early discharge or as needed for Neurologic Exam changes on exam
- Indications to consider early discharge after repeat Head CT (at 6 hours)
- Glasgow Coma Scale (GCS) 15
- No Anticoagulation or antiplatelet agents
- Safe home social situation (e.g. not homeless, available for close interval follow-up)
- Small peripheral Subarachnoid Hemorrhage consistent with Traumatic SAH
- Central SAH is much more suggestive of Aneurysmal SAH
- References
- Marcolini and Swaminathan in Swadron (2023) EM:Rap 23(5): 13-4
VII. References
- Swaminathan and Marcolini in Herbert (2017) EM:Rap 17(6):17-18
- Burgess and Stowens (2014) Crit Dec Emerg Med 28(5): 2-13
- Levy (2015) Crit Dec Emerg Med 29(4): 10-4
- Bederson (2009) Stroke 40(3): 994-1025 [PubMed]
- Cohen-Gadol (2013) Am Fam Physician 88(7): 451-6 [PubMed]
- van Gijn (2007) Lancet 369(9558): 306-18 [PubMed]