Subarachnoid hemorrhage
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Subarachnoid hemorrhage
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Nervous system pathology review
Congenital neurological disorders: Pathology review
Headaches: Pathology review
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Cerebral vascular disease: Pathology review
Traumatic brain injury: Pathology review
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Subarachnoid hemorrhage
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Headache p. 536
subarachnoid hemorrhage p. 532, 533, 719
Hemorrhage
subarachnoid hemorrhage p. 532, 533
Subarachnoid hemorrhage p. 532, 536
labs/findings p. 722
nimodipine for p. 325
presentation p. 719
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Transcript
There are two main types of stroke: a hemorrhagic stroke, which occurs when an artery ruptures and bleeds within the brain, and an ischemic stroke, which occurs when an artery gets blocked.
Hemorrhagic strokes can be further split into two types, an intracerebral hemorrhage which is when bleeding occurs within the cerebrum, and a subarachnoid hemorrhage which is when bleeding occurs between the pia mater and arachnoid mater of the meninges - the inner and middle layers that wrap around the brain.
We’ll focus on subarachnoid hemorrhage, which can quickly lead to death if they’re left untreated.
Subarachnoid hemorrhages can lead to a pool of blood under the arachnoid mater that increases the intracranial pressure and prevents more blood from flowing into the brain.
Ok - let’s start with three protective layers of the brain called meninges.
The inner layer of the meninges is the pia mater, the middle layer is the arachnoid mater, and the outer layer is the dura mater.
Between the arachnoid mater and the pia mater is the subarachnoid space, which houses cerebrospinal fluid, or CSF.
CSF is a clear, watery liquid which is pumped around the spinal cord and brain, cushioning them from impact and bathing them in nutrients.
Summary
A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space, the area between the arachnoid membrane and the pia mater surrounding the brain. This may occur spontaneously, usually from a ruptured cerebral aneurysm, or may result from a head injury.
Symptoms of subarachnoid hemorrhage can include sudden, severe headache; nausea and vomiting, confusion, or reduced level of consciousness. Diagnosis is usually done with a CT or MRI that shows blood in the subarachnoid space and blood in a lumbar puncture. Treatment requires prompt surgery to stop the bleeding and prevent further damage. Medications may also be prescribed to reduce swelling and control seizures.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "NEUROwords Dr. Thomas Willis’ Famous Eponym: The Circle of Willis" Journal of the History of the Neurosciences (2005)
- "Cerebral Aneurysms" New England Journal of Medicine (2006)
- "Subarachnoid Hemorrhage" Emergency Medicine Clinics of North America (2016)
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