Subarachnoid hemorrhage in the brain: symptomatology, choice of therapy tactics and consequences

Features of the disease

Hemorrhages in the subarachnoid space( a gap between the cerebralshells) in the majority of cases occur spontaneously. The person at the same time feels a sudden headache and nausea. Some people start vomiting, others lose consciousness.

Subarachnoid hemorrhage occurs due to complete vascular rupture or partial tear of the cerebral artery

.The cause of this are various pathological processes, most often - aneurysms( protrusion of the walls of blood vessels) and traumatic lesions.

Blood accumulates in the basal tanks, so the disease can be called basal subarachnoid hemorrhage. Aneurysm ruptures result in the starting to enter the cerebrospinal fluid .At the same time, a marked spasm of the arteries of the brain is observed, its edema develops, and neurons begin to die.

Prevalence of the disease and stages of its development

Among all forms of circulatory disorders in the brain of ASA, occurs in 1-7% of cases of .Spontaneous subarachnoid hemorrhage occurs in 8-12 people out of 100 thousand annually. Its traumatic form is more common. Depending on the situation, the frequency of subarachnoid hemorrhage in craniocerebral trauma varies from 8 to 59%.

Almost 85% of cases occur due to a rupture of the arteries of the brain, which are located in the Willis circle. About half of the subarachnoid hemorrhage ends in a lethal outcome. Of these, 15% of patients do not have time to reach the hospital .

Allocate 3 stages of development of traumatic subarachnoid hemorrhage.

1. The blood that has entered the subarachnoid space begins to spread through the liquor-bearing canals. At the same time, the volume of CSF increases and intracranial hypertension develops.
2. In the cerebrospinal fluid, the blood begins to clot, clots form. They block the cerebral pathways. As a result of this condition, liquorocirculation is disrupted, intracranial hypertension begins to increase.
3. Dissolution of blood that has contracted is accompanied by the appearance of a meningeal syndrome and signs of the onset of aseptic inflammation.

Classification of severity of conditions

Doctors use three methods that allow you to assess the severity of the lesion. When classifying by Hess and Hunt, 5 levels of are distinguished:

• Asymptomatic course or minor manifestations in the form of mild headache and stiff neck. Survival in this state is 70%.
• Medium or severe pain, severe neck stiffness, paresis of the nerves of the skull. The chances of survival do not exceed 60%.
• Neurological deficiency in minimal manifestations, stunning. Only 50% of patients survive.
• A congenital condition, manifestations of moderate or severe hemiparesis, vegetative disorders, signs of decerebral rigidity. The probability of surviving does not exceed 20%.
• Agony, deep coma, decerebrate rigidity. In this condition, 90% of patients die.

The Fisher Scale , modified by Klaassen and his co-authors, is based on the results of computed tomography. Four degrees of damage are distinguished:

• The first level is assigned when the hemorrhage is not visualized.
• On the second level it is in those cases where the thickness of the lesion is less than 1 mm.
• At the third level, the thickness exceeds 1 mm.
• The fourth level of SAK is diagnosed in cases when intraventricular hemorrhages are visualized or spread to the cerebral parenchyma, regardless of thickness.

The World Federation of Neurosurgeons uses the Glasgow Coma Scale and estimates a focal neurological deficit:

• There is no neurological deficit at level 1, 15 points on the SCG.
• To assign 2 levels according to the ShKH should be from 13 to 14 points and the absence of a neurological deficit.
• For signs of lesions of the central or peripheral nervous system and 13-14 balls according to the ShKG, level 3 is established.
• According to the ShKG, 7-12 points are established, the presence of focal neurological deficit is not important.
• less than 7 points were awarded for the ShKG.

Causes and Risk Factors

SAK occurs due to violations of the integrity of the walls of the arteries that pass inside the skull. They are located on the top of the cerebral hemispheres or at its base. There are such causes of damage to the arteries:

• traumatic lesions: traumatic brain injury, in which the brain contusion and arterial damage are diagnosed;
• spontaneous violations of the integrity of the walls;
• ruptures of aneurysms;
• ruptures of arteriovenous malformations.

To the risk factors, the specialists include:

• the use of alcohol and narcotic drugs;
• high blood pressure;
• atherosclerosis of vessels;
• infections in which the cerebral arteries( syphilis) are damaged.

Clinic: signs and symptoms

Calling for an ambulance for subarachnoid hemorrhage is necessary if, against a background of normal state of health, a person is noted:

• pain in the head, which increases with any activity;
• nausea and vomiting;
• appearance of psychoemotional disorders: fear, drowsiness, increased excitability;
• convulsions;
• is a disorder of consciousness: stun, faint, or coma appears;
• temperature rose to febrile and subfebrile values;
• photophobia.

Separately distinguish the signs that arise in violation of the functioning of the cerebral cortex and brain nerves .This is evidenced by:

• loss of sensitivity of the skin;
• speech problems;
• appearance of strabismus.

A few hours after the outflow of blood, symptoms of meningitis appear:

• is a Kernig attribute( a person can not unbend a leg that was bent simultaneously in the knee and hip joints);
• stiffness of the occiput muscles( the patient does not reach the neck with the chin).

On problems with frontal lobes will testify:

• speech impairment;
• cramps on the fingers;
• is a shaky walk;
• speech disorders;
• behavior changes.

If the is damaged, the temporal lobe of will lose hearing, memory impairments, auditory hallucinations and tinnitus occur.

Violation of the ability to read, loss of tactile sensations, ability to orientate indicates problems in the parietal lobe .

Damage to of the occipital lobe of is manifested by visual impairment and the appearance of visual hallucinations.

Diagnostics and first aid

The doctor evaluates the patient's condition and prescribes the CT scan. With the help of CT:

• , the site where the outflow of blood has occurred is detected;
• obtains data on the cerebrospinal fluid system;
• is checked to see if there is swelling in the brain.

High-precision CT angiography allows you to find out where is the source of bleeding .Negative CT results are associated with minor hemorrhage. Also they happen at carrying out of diagnostics in late terms.

When negative results are obtained, is assigned a lumbar puncture and examination of the cerebrospinal fluid. SAC is indicated by the increasing concentration of red blood cells.

If the disease is caused by an aneurysm, angiography of vessels is performed. They inject a radiopaque substance and make x-rays. In damaged areas, an endovascular operation is performed.

First aid is directed to stabilize the patient's condition. It needs to be delivered to the hospital when the first symptoms of appear.

Treatment aimed at stopping bleeding and removing its source is under way. It is important to prevent the development of complications and the occurrence of relapses.

Tactics of treatment

Patients with SAK immediately prescribe drugs that normalizes intracranial and blood pressure .If the patient is unconscious, then he is intubated with a trachea and a mechanical ventilation device is connected.

People with massive hemorrhages make urgent operations to extract the hemorrhagic contents of .The rest is treated, which should reduce the risk of repeated bleeding.

Before the doctor there are such tasks:

• to achieve stabilization of the state;
• prevent relapse;
• normalize homeostasis;
• minimize the manifestations of the disease, which led to the defeat;
• to treat and prevent vasospasms and cerebral ischemia.

Water balance check and evaluation of kidney function are performed using a urinary catheter. People are fed with SAK using a nasogastric tube or parenterally. Compression linens help prevent vein thrombosis.

If the cause of the disease is an aneurysm, then during the angiography can clip the problem vessel or clog it .

Symptomatic treatment with is also performed:

• patients who start convulsions, are prescribed anticonvulsants;
• people with brain edema are injected with diuretics;
• with repeated vomiting give antiemetics.

Rehabilitation procedures

With the help of timely and adequate treatment, many seek to normalize the state after cerebral hemorrhage. Recovery lasts not less than 6 months.

Complete rehabilitation is impossible without daily medication, monitoring the condition in the dynamics and constant visits to the neurologist.

Expected prognosis and possible complications of

The effects of subarachnoid hemorrhage in the brain depend on the causes that caused it, and how quickly the patient was hospitalized, how adequate the treatment was. Affects the prognosis of patients' age and bleeding profuse.

The most serious complication of subarachnoid hemorrhage of the brain is vasospasm. This vasospasm leads to ischemic brain damage. In severe cases, a lethal outcome is possible. Deferred ischemia of occurs in 1/3 of patients, half of them have an irreversible neurological deficit.

To prevent the development of vasospasm allows the introduction of calcium channel blockers. But with traumatic lesions, such drugs are not used.

There are other consequences:

• Relapse. It happens both in the early period, and after a certain period of time.
• Hydrocephalus - cerebrospinal fluid accumulates in the ventricles of the brain. Occurs in the early and remote periods.
• Swelling of the lung, ulcerous bleeding, myocardial infarction. These complications are rare.

Among the remote consequences are called:

• attention violation;
• memory problems;
• fatigue;
• psychoemotional disorders.

Preventative measures to prevent recurrence of

To minimize the negative consequences, it is necessary to remember how prophylaxis of subarachnoid hemorrhages is carried out:

• Full nutrition, in which the body receives large quantities of fruits and vegetables, the amount of fatty and fried foods decreases.
• Refusal from drugs, alcohol, cigarettes.
• Gradual input of moderate load( swimming, jogging, jogging).
• Regular walks.
• Pressure control( learn how to choose a tonometer for home use) and blood glucose concentrations.

These preventative measures of reduce the risk of subarachnoid hemorrhage.

In time, the established diagnosis and treatment measures allow patients to recover .But the negative consequences of subarachnoid hemorrhage, representing a danger to life, occur in 80% of patients. Prevent this will help the use of preventive measures.

This video presents a lecture on the treatment of subarachnoid hemorrhage: