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Subarachnoid Hemorrhage

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Normal

Abnormal
  • A Subarachnoid Hemorrhage is the bleeding in the subarachnoid space of the brain.  This is a tissue area that surrounds the brain, resulting in Stroke symptoms i.e., brain damage.

  • A sudden onset of the "worst headache" of the person's life. Often described as a "thunder-clap"
  • Nausea and or Vomiting
  • Loss of consciousness
  • Confusion and or Irritability
  • Impaired mental function
  • Coma


  • Examination:

    1. Nuchal (Neck) rigidity
    2. Signs of meningeal irritation
    3. Paralysis may be present
  • Testing:
    1. CAT scan to check for the Subarachnoid Hemorrhage.
    2. If the CAT scan is normal, but Subarachnoid Hemorrhage is suspected, then a lumbar puncture (spinal tap) is performed and examined for blood or xanthochromia.
    3. Cerebral Angiogram, where a dye is injected and X-Rays of the blood vessels in the brain are taken, may be necessary to find the site of bleeding (e.g., a ruptured aneurysm).
    4. MR Angiogram may be considered, but it is not as accurate as a Cerebral Angiogram

  • Supportive measures such as strict bed rest and avoidance of straining in any way (even for a bowel movement)
  • Treat severe Hypertension, but do not lower the diastolic blood pressure (the lower number) below 100 mm Hg.
  • Dilantin (Phenytoin) is often prescribed for seizure prevention.
  • Surgical intervention, e.g., the repair of a ruptured Cerebral Aneurysm or arteriovenous malformation if the patient can be stabilized.

  • The patient needs immediate emergency medical treatment.




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