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Presented at the Second Neurosurgical MasterClass, Cluj-Napoca, 2014.
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Subarachnoid Hemorrhage
1.
Subarachnoid Hemorrhage (SAH) IonuĹŁ CÄrÄvan Coordinated
by Prof. Ioan Ĺtefan Florian, MD, PhD University of Medicine and Pharmacy âIuliu HaĹŁieganuâ Cluj Napoca
2.
Definition ⢠SAH =
extravasation of blood into the subarachnoid space
3.
Etiology Greenberg Handbook of
Neurosurgery, 2010 ď§ Traumatic SAH ď§ Non-traumatic (spontaneous) SAH oruptured intracranial aneurysms (75 %) oAVM (5 %) oothers (tumor, vasculitis, coagulation disorders, dural sinus thrombosis) ounknown etiology (15 %)=âangiogram-negative SAHâ
4.
Presenting features(1) ⢠HEADACHE
(âthunderclap headacheâ) ⢠meningismus ď§ neck stiffness ď§ photophobia ď§ back pain
5.
Presenting features(2) ⢠decreased
state of consciousness ⢠nausea and vomiting ⢠seizures ⢠focal neurologic deficits: ď§ oculomotor palsy ď§ hemiparesis ⢠ocular hemorrhage
6.
Radiographic findings ⢠CT
scan ⢠Cerebral Angiography ⢠FLAIR* MRI ⢠CT Angiography ⢠MRA** *Fluid-attenuated inversion recovery **Magnetic Resonance Angiography
7.
CT scan
8.
Lumbar puncture
9.
Grading SAH Hunt and
Hess Grade WFNS* Grading *World Federation of Neurological Surgeons
10.
Complications ⢠Hydrocephalus ⢠Vasospasm
=> delayed cerebral ischemia ⢠Seizures ⢠Rebleeding ⢠Intracerebral hemorrhage ⢠Intraventricular hemorrhage ⢠Left ventricular systolic dysfunction ⢠Subdural hematoma
11.
Treatment ⢠BP control
(fluid restriction and antihypertensive therapy) when the mean arterial pressure exceeds 130 mm Hg ⢠ICP control (osmotic agents, loop diuretics) ⢠Symptomatic treatment: â anticonvulsants: levetiracetam, phenytoin â analgesics: fentanyl â anti-emetics: odansetron â calcium channel blockers: nimodipine, verapamil => vasospasm !!! Prevention of rebleeding: ⢠antifibrinolytic therapy ⢠surgical treatment ⢠endovascular treatment
12.
References ⢠MS Greenberg.
Handbook of Neurosurgery. Seventh Edition. New York: Thieme Medical Publishers; 2010. ⢠AH Kaye. Essential Neurosurgery. Third Edition. Oxford: Blackwell Publishing Ltd; 2005. ⢠MG Yasargil. Microneurosurgery. New York: Thieme Medical Publishers Inc; 1994.
13.
Thank you!
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