Subarachnoid haemorrhage( ASA) is an hemorrhage into the subarachnoid space located between the soft and arachnoid skin of the brain , which occurs for various reasons.
This is a condition that threatens the life and health of the patient, even in the situation of timely therapy.
About half of cases result in death of a person.
Contents
- Causes of the disease
- Classification
- Clinical picture of the pathology
- Diagnostic criteria
- Therapeutic tactics
- Possible consequences and complications of the disease
- Forecast
Causes of the disease
The main causes of the appearance of this pathology are non-traumatic:
- rupture of congenital or acquired cerebral aneurysm;
- rupture of the blood supply system of the brain on the background of arterial hypertension, cerebral artery atherosclerosis and other vascular diseases.
And traumatic factors:
- fracture of the skull bones;
- brain injury;
- traumatic brain injury.
One of the risk factors for the occurrence of SAK vascular etiology is the patient's age and concomitant diseases of the heart and blood vessels.
Traumatic subarachnoid hemorrhage most often occurs due to traffic accidents, people in a state of intoxication and sportsmen of contact types of struggle.
Classification of
In order to assess the patient's condition and the severity of the disease, several evaluation methods were developed using a scale system and scores.
- The severity scale, which consists of five levels: from mild or asymptomatic to agonal and coma.
- Fisher scale analyzes the data obtained as a result of computed tomography. It takes into account the visualization and volume of hemorrhage, as well as its prevalence to other parts of the brain.
- The combination of the classical coma scale, Glasgow ( estimates speech, motor reactions and degree of opening of the eyes) and focal neurological deficit( neurological signs that appear when certain areas of the brain are affected).
To establish the degree of severity, take into account the totality of evaluation results for all scales, as well as the location and size of the aneurysm.
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Clinical picture of the pathology of
Subarachnoid hemorrhage develops rapidly against the background of the patient's normal state of health and has such symptoms:
- is a sharp and severe headache that increases with minimal physical activity;
- vomiting, nausea;
- psychoemotional disorders: agitation, fear, drowsiness;
- convulsions;
- temperature increase to subfebrile and febrile values;
- various disorders of consciousness from stunning to fainting and coma;
- signs of oculomotor nerve lesion( eyelid drooping, paresis of eyes, etc.) and hemorrhage into the eyeball.
A few hours after the episode of hemorrhage, meningeal symptoms manifest:
- stiff neck - impossibility to touch the neck with the chin;
- is a symptom of Kernig - the inability to unbend the leg, previously bent in the knee and hip joints, and some others.
The emergence of SAA due to a traumatic brain injury may be accompanied by focal symptoms of damage to certain areas of the brain:
- Frontal lobe of : unsteady gait, paralysis of limbs, speech disturbance, behavior change and disinhibition of consciousness, cramps of fingers and others.
- Temporal fraction of : hearing loss, ear noise and auditory hallucinations, memory impairment, etc.
- dark share: loss of tactile perception, impaired ability to read, orientate, etc.
- Occipital part : visual impairment, peculiar visual hallucinationsetc.
Possible pressure increase, arrhythmia development, pulmonary edema and possibly cardiac arrest.
Symptomatic of the disease is expressed in varying degrees and can persist for several days to a couple of weeks. At later stages of the patient, headaches, impaired consciousness, changes in temperature are disturbed.
A new episode of hemorrhage strengthens the symptoms and adds new ones.
Diagnostic criteria
The doctor specifies the patient's history and performs an external examination in order to identify the characteristic symptoms.
The diagnosis is made on the basis of CT data, which allows not only to detect hemorrhage, but also to obtain data on the state of the cerebrospinal fluid, the prevalence of the process, and the presence of cerebral edema.
Conducting high-precision CT angiography allows you to clarify the source of bleeding.
Negative results on CT in a characteristic clinical picture may be associated with a small amount of hemorrhage and the conduct of a study at a later date.
MRI is less commonly used for early diagnosis, but is a more sensitive method for diagnosing pathology after a few days.
With negative results, CT is performed by lumbar puncture followed by examination of cerebrospinal fluid.
In the photo subarachnoid hemorrhage on CT
After confirmation of the diagnosis, the SAK are engaged in establishing the cause and source of hemorrhage. The most frequent cause of pathology is an aneurysm, which requires angiography of cerebral vessels or CT angiography.
Angiography of cerebral vessels - a radiocontrast agent( iodine preparations) is introduced into the vessel and a series of radiographic photographs is simultaneously performed.
In the course of the study, endovascular surgery on the damaged portion of the vessel can be performed.
Treatment tactic
Treatment is performed in a specialized neurological hospital taking into account the severity of the patient's condition.
Key objectives of the treatment:
- to stabilize the patient;
- prevention of recurrence of the SAC episode;
- normalization of homeostasis( balance maintenance system);
- treatment and prevention of cerebral ischemia and vascular spasm;
- therapy is a disease that caused a hemorrhage.
Depending on the degree of impairment of consciousness and symptoms, the patient's condition should be stabilized:
- in case of impaired consciousness, intubate the trachea and connect the patient to the ventilator;
- manipulation requires the introduction of painkillers and sedatives;
- installation of a urinary catheter to monitor kidney and water balance;
- nutrition either parenteral( via a vein) or with a nasogastric tube;
- with convulsive seizures apply anticonvulsants;
- for the prevention of thrombosis use compression linen;
- administration of diuretics for edema of the brain;
- antiemetics with repeated vomiting.
Depending on the size of the aneurysm, its location and other parameters during the angiography, vascular clipping or endovascular occlusion( occlusion) is used.
For the treatment of vasospasm( spasm of blood vessels causing a decrease in blood flow) and ischemia( insufficiency of blood supply) of the brain, calcium channel blockers in tablet form( nimodipine) are used.
In cases of local vasospasm, refined by angiography, drugs are administered that expand the artery directly into the vessel or conduct balloon angioplasty.
Treatment is carried out under the constant control of the main indicators of the blood system, water-salt balance, intracranial and arterial pressure.
Possible consequences and complications of
The most common consequences after subarachnoid hemorrhage:
- Spasm of vessels and consequent development of cerebral ischemia.
- The recurrence of the SAK episode in the aneurysm of , can develop both in the early period and after a few weeks.
- Hydrocephalus ( accumulation of cerebrospinal fluid in the ventricular system of the brain) can occur in the initial stages or in the distant period.
- pathology of other organs and systems develops less often: pulmonary edema, myocardial infarction, bleeding from stomach ulcers or duodenal ulcer, etc.
From the long-term consequences, most often develop psychoemotional disorders( depression, insomnia, agitation, etc.), violationmemory and attention.
The standard complaint in most patients with cerebral hemorrhage is a headache, there is less development of hormonal regulation in the hypothalamic and pituitary system.
Forecast
The prognosis depends on the cause of the hemorrhage, its volume and location, and the speed of the treatment.
And only a small percentage of patients survive the episode of SAK without significant consequences. 
Subarachnoid hemorrhage is a serious life threatening condition that can occur due to traumatic and non-traumatic causes.
Many factors affect the development of consequences and complications: the cause of SAH, concomitant diseases, the timeliness of diagnosis and the volume of medical care provided.
