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A subarachnoid haemorrhage is a condition in which blood flows into the space between the arachnoid and soft dura (the subarachnoid space) where the cerebrospinal fluid is located. Every year, about 3 new cases are registered in Poland, a quarter of which is fatal.
The causes of subarachnoid hemorrhage
Subarachnoid hemorrhage may be a consequence of:
- previous head injury,
- the presence of a hemorrhagic diathesis,
- aneurysm rupture (most common),
- cerebral hemangioma (rare).
How is subarachnoid hemorrhage manifested?
Subarachnoid hemorrhage usually begins suddenly and unexpectedly, even while you are feeling well and healthy.
Some patients with headaches a few days or weeks before the hemorrhage do, but they do not stand out in anything special that would make it possible to suspect a haemorrhage.
Severe headache occurs suddenly, sometimes under circumstances suggesting an association with an increase in blood pressure:
- physical activity;
- passing a stool
- cough,
- emotions.
However, in most patients, the pains have nothing to do with it. The headache grows noticeably with every movement. From the very beginning, it is often accompanied by nausea and vomiting, and a longer or shorter-lasting loss of consciousness. Seizures, paralysis of eye movements or mental disorders are less common.
The severity of symptoms, such as the intensity of the headache or prolonged loss of consciousness, and symptoms that indicate brain damage, can be used to determine the severity of the disease, which can range from mild (slight headaches with complete consciousness) to extremely severe (complete coma with limb paralysis).
The patient’s condition may change rapidly in the first dozen or so days, deterioration of health may be the result of:
- complications such as swelling of the brain or spasm of the cerebral arteries causing ischemia
- re-bleeding occurs in 25% of patients.
If a subarachnoid haemorrhage is suspected, the patient should be transferred to a hospital with appropriate diagnostic equipment as soon as possible.
Diagnostics of subarachnoid hemorrhage
The diagnosis of subarachnoid haemorrhage can be made with a high degree of possibility on the basis of the clinical picture alone, but additional tests should be performed to obtain 100% certainty. Computed tomography can detect extravasated blood, as well as approximate the amount of extravasated blood and help determine the possible cause of bleeding (e.g. an aneurysm).
The assessment of subarachnoid hemorrhage can also be done by testing the cerebrospinal fluid for the presence of blood admixtures. This method is used when there is no possibility of immediate computed tomography.
Subarachnoid haemorrhage – treatment
A patient who has had subarachnoid haemorrhage should be kept in the supine position. If there are no complications, the patient should remain immobilized for approximately four weeks after the onset of bleeding. If an aneurysm is detected – an operation should be performed to protect the patient from the occurrence of another bleeding from the aneurysm.
If the patient’s condition allows it, surgery should be performed as soon as possible to prevent a dangerous recurrence of bleeding.
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