Subarachnoid hemorrhage natural history, complications and prognosis: Difference between revisions
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Nearly half the cases of SAH are either dead or moribund before they reach a hospital. Of the remainder, a further 10-20% die in the early weeks in hospital from rebleeding. Delay in diagnosis of minor SAH without coma (or mistaking the sudden headache for [[migraine]]) contributes to this mortality. Patients who remain comatose or with persistent severe deficits have a poor prognosis.<ref name="pmid23117495">{{cite journal| author=Biesbroek JM, van der Sprenkel JW, Algra A, Rinkel GJ| title=Prognosis of acute subdural haematoma from intracranial aneurysm rupture. | journal=J Neurol Neurosurg Psychiatry | year= 2013 | volume= 84 | issue= 3 | pages= 254-7 | pmid=23117495 | doi=10.1136/jnnp-2011-302139 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23117495 }} </ref> | Nearly half the cases of SAH are either dead or moribund before they reach a hospital. Of the remainder, a further 10-20% die in the early weeks in hospital from rebleeding. Delay in diagnosis of minor SAH without coma (or mistaking the sudden headache for [[migraine]]) contributes to this mortality. Patients who remain comatose or with persistent severe deficits have a poor prognosis.<ref name="pmid23117495">{{cite journal| author=Biesbroek JM, van der Sprenkel JW, Algra A, Rinkel GJ| title=Prognosis of acute subdural haematoma from intracranial aneurysm rupture. | journal=J Neurol Neurosurg Psychiatry | year= 2013 | volume= 84 | issue= 3 | pages= 254-7 | pmid=23117495 | doi=10.1136/jnnp-2011-302139 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23117495 }} </ref> | ||
*The Hunt and Hess scale describes the severity of [[subarachnoid hemorrhage]], and is used as a predictor of survival.<ref name="pmid5635959">{{cite journal| author=Hunt WE, Hess RM| title=Surgical risk as related to time of intervention in the repair of intracranial aneurysms. | journal=J Neurosurg | year= 1968 | volume= 28 | issue= 1 | pages= 14-20 | pmid=5635959 | doi=10.3171/jns.1968.28.1.0014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5635959 }} </ref> | |||
{| style="bo[[Link title]]rder: 0px; font-size: 90%; margin: 3px;" align=center | |||
|+ | |||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Grading}} | |||
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Associations}} | |||
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Survival}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Grade 1''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Asymptomatic | |||
*Minimal headache and slight neck stiffness | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*70% survival | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Grade 2''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Moderate to severe headache | |||
*Neck stiffness | |||
*No neurologic deficit except [[cranial nerve palsy]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*60% survival | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Grade 3''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Drowsy | |||
*Minimal neurologic deficit | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*50% survival | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Grade 4''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*[[Stuporous]] | |||
*Moderate to severe [[hemiparesis]] | |||
*Early decerebrate rigidity | |||
*Vegetative disturbances | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*20% survival | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" | '''Grade 5''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*Deep coma | |||
*[[Decerebrate rigidity]] | |||
*[[Moribund]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" | | |||
*10% survival | |||
|} | |||
==References== | ==References== | ||
Revision as of 21:23, 7 December 2016
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Subarachnoid Hemorrhage Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012)
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Sara Mehrsefat, M.D. [3]
Overview
Natural history
Following rupture of an aneurysm, the blood directly release into the cerebrospinal fluid (CSF) under arterial pressure. As the blood spreads quickly into the CSF, it rapidly increasing intracranial pressure.[1]
Depending on the location of the aneurysm, the blood can spread into:
- Intraventricular space
- Brain parenchyma
- Subdural space
The bleeding usually lasts only a few seconds. However, rebleeding can be considered as one of the complication which can occur within the first day.[2]
Complications
Complications of SAH can be acute, subacute, or chronic.
- Acute:
- Coma and brainstem herniation due to increased intracranial pressure (ICP)
- Pulmonary edema ("neurogenic pulmonary edema") as a result of the suddenly increased ICP
- Cardiac arrhythmias and myocardial damage
- Hydrocephalus, which may also happen in the subacute time frame
- Subacute:
- Vasospasm, leading to ischemia of the brain
- Hyponatremia (low sodium levels) - due to SIADH or cerebral salt wasting syndrome
- Chronic:
- Long-term immobility
- Pneumonia and pulmonary embolism (due to immobility)
- SAH recurrence (20% within two weeks if the aneurysm is not secured by clipping or coiling)
- Persistent neurologic deficits
Prognosis
Nearly half the cases of SAH are either dead or moribund before they reach a hospital. Of the remainder, a further 10-20% die in the early weeks in hospital from rebleeding. Delay in diagnosis of minor SAH without coma (or mistaking the sudden headache for migraine) contributes to this mortality. Patients who remain comatose or with persistent severe deficits have a poor prognosis.[2]
- The Hunt and Hess scale describes the severity of subarachnoid hemorrhage, and is used as a predictor of survival.[3]
| Grading | Associations | Survival |
|---|---|---|
| Grade 1 |
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| Grade 2 |
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| Grade 3 |
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| Grade 4 |
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| Grade 5 |
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References
- ↑ Schuss P, Konczalla J, Platz J, Vatter H, Seifert V, Güresir E (2013). "Aneurysm-related subarachnoid hemorrhage and acute subdural hematoma: single-center series and systematic review". J Neurosurg. 118 (5): 984–90. doi:10.3171/2012.11.JNS121435. PMID 23289820.
- ↑ 2.0 2.1 Biesbroek JM, van der Sprenkel JW, Algra A, Rinkel GJ (2013). "Prognosis of acute subdural haematoma from intracranial aneurysm rupture". J Neurol Neurosurg Psychiatry. 84 (3): 254–7. doi:10.1136/jnnp-2011-302139. PMID 23117495.
- ↑ Hunt WE, Hess RM (1968). "Surgical risk as related to time of intervention in the repair of intracranial aneurysms". J Neurosurg. 28 (1): 14–20. doi:10.3171/jns.1968.28.1.0014. PMID 5635959.