The Puzzle of Spontaneous versus Traumatic Subarachnoid Hemorrhage

Abstract

Subarachnoid hemorrhage (SAH) is a neurological emergency, presents frequently, and is highly morbid and fatal. It is defined as bleeding into the subarachnoid space or basal cisterns, i.e., cavities between the pia mater and the arachnoid, and normally occupied by cerebrospinal fluid (CSF). [1][2][3][4] Its nature of presentation is sometimes independent of any predisposing comorbidity, and hence presents in the young adult population (peak in the sixth decade of life). These individuals are completely independent and healthy and thus add this pathology within the framework of entities that constitute an important and heavy socio-health burden. It represents expenditure greater than twice the ischemic cerebrovascular events, [5,6] and this entity has an effect on the loss of years of life that is almost equal to that of the most common cerebrovascular entities. [7] The present article intends to explore the epidemiological, pathophysiological, clinical, diagnostic, therapeutic, and other considerations about traumatic SAH (tSAH) and spontaneous or aneurysmal SAH (aSAH) origin. epIdeMIologyTrauma is the most frequent cause of SAH, and SAH is the most common form of intracranial hemorrhage in trauma. [1,4,8] It has been reported that 26%-53% of all trauma cases develop tSAH. [8] The distinction of tSAH and nontraumatic is well recognized. Among spontaneous SAH, 80%-85% is due to the spontaneous rupture of an aneurysm (aSAH), usually not congenital, [1] which constitutes around 5% (fluctuating between 1% and 6%) of all cerebrovascular diseases; [3,4,6,7,9] the remaining 20% represents a wide range of causes of bleeding, [7,10] such as cerebral amyloid angiopathy (non-tSAH more common in people over 60 years of age) and reversible cerebral vasoconstriction syndrome, among others; some of

Planning neurosurgical interventions in patients with anticoagulant therapy

“…Decompressive Craniectomy (DC) is commonest treatments in treatment of high ICP since last century to maintain intracranial equilibrium 35 in high ICP from cerebral tumors, neuroinfections, TBI, ICH (whether spontaneous or traumatic) [36][37][38][39] to avoid neurological complications, secondary insults, brain herniation and unfavorable outcomes including death 40,41 . There is a high risk of DVT after DC that need antithrombotic measurements and imaging studies 22 ; patients under anticoagulation should have coagulation profile; if abnormal, suspend the therapy and/or restore the coagulation time within 48 hours 1,22 as damaged tissues and platelets produce excessive thromboplastin and vasoconstrictors that might produce acidosis status and ischemia 22 .…”

Changes in Electrocardiogram in Patients With Spontaneous Subarachnoid Hemorrhage: A Cross-Sectional Study

“…Subarachnoid hemorrhage is a worldwide health burden with high mortality and morbidity among survivors. The overall incidence of SAH is 7-11 per 100 000 inhabitants/year with a higher incidence in Japan and Finland [ 1 ]. Most SAHs are caused by ruptured saccular aneurysms.…”