Subarachnoid

Haemorrhage
 Outline :

 Introduction
 Content
 1. Definition
 2. Anatomy
 3. Etiology and pathophysiology
 4. Sign and symptoms
 5. Diagnosis
 6. Risk Factors and Treatment
 Conclusions
 Introduction

 Subarachnoid hemorrhage (SAH) Sudden bleeding
in the subarachnoid space due to a pathological
process.
 The incidence of SAH ranged from 2 to 16 per 100
000.
 Female > Male  the ratio is 1.6 for female.
CONTENT
DEFINITION
 Subarachnoid haemorrhage  Sudden Bleeding  Subarachnoid Space
 the innermost membrane surrounding the central nervous system.
Anatomy

 Baehr M, Frotscher M, Duus P. Duus' topical diagnosis in neurology. 4th ed.

Stuttgart: Thieme; 2005.
ETIOLOGY
Trauma (most common cause of SAH)  80%
The rupture of an intracranial aneurysm  85% of SAH incident
10%  non-aneurysmal conditions
5%  other medical conditions
Genetic  rare
Pathophysiology
• Aneurysms  dilatation of an intracranial
• occur in the terminal portion of the internal carotid artery and
the branching sites on the large cerebral arteries in the
anterior portion of the circle of Willis.
cont
• Aneurysm ruptures  blood extravasates under arterial pressure
 subarachnoid space  spreads through the cerebrospinal
fluid.
• Blood released under high pressure may directly cause damage
to local tissues.
• Blood extravasation  ICP
• Intracranial pressure  systemic symptoms (Ex: bradycardia,
hypertension)
• Focal neurological signs  false localization effect of increased
intracranial pressure
• Sudden onset  Headache (Thuderclap)
• Seizure at the onset of hemorrhage
• Transient loss of consciousness
• Vomiting
• Sentinel headache
• Neck pain
• Photophobia
• CT-Scan

• MRI

• Kirkpatrick P. Subarachnoid haemorrhage and intracranial aneurysms : what neurologist need to know.
Neurol Neurosurg Psychiatry. 2002:i28-i33.
 Smoking
 Heavy alcohol consumption
 The risk of AVM rupture is greater during
pregnancy
 Familial Predisposition  Non-
Modifiable
TREATMENT
 Vital Function Stabilize
 Clipping

 Endovascular Coiling

 Antifibrinolytic

 Antihypertensives
 Conclusions

 Subarachnoid haemorrhage  sudden bleeding 
subarachnoid space  High mortality rate
 Most of SAH cases are arising from rupture of a
vascular abnormality such as an intracranial
aneurysm and cerebral arteriovenous malformations.
 Treatment  prevent SAH cases for becoming death
and disability  Surgical clipping of cerebral
aneurysms has historically been the definitive
treatment.
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