Subarachnoid haemorrhage

@article{Gijn2007SubarachnoidH,
  title={Subarachnoid haemorrhage},
  author={Jan C van Gijn and Richard S. C. Kerr and Gabriel J E Rinkel},
  journal={The Lancet},
  year={2007},
  volume={369},
  pages={306-318}
}

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TLDR
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Diagnosis, Medical Management, and Complications of Aneurysmal Subarachnoid Hemorrhage
TLDR
The clinical hallmark of aSAH, in an awake patient, is the complaint of the sudden onset of the “worst headache of life” (Bassi P, Acta Neurol Scand 84(4):277–81, 1991), which is preceded 7–30 days by a warning or sentinel headache.
Clinical Signs and Symptoms of Subarachnoid Hemorrhage Signs at presentation Patient experiences the worst headache of his or her life
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If there is reasonable suspicion of SAH, the patient should be urgently transferred to a highvolume treatment center that has experienced surgeons, because these centers have been associated with better outcomes.
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References

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Subarachnoid haemorrhage: diagnosis, causes and management.
TLDR
Once ischaemia has occurred, treatment regimens such as a combination of induced hypertension and hypervolaemia, or transluminal angioplasty, are plausible, but of unproven benefit.
Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan?
TLDR
In patients with sudden headache but normal CT a deferred lumbar puncture is necessary to rule out subarachnoid haemorrhage, even if CT is performed within 12 hours after the onset of symptoms.
Delirium in Acute Subarachnoid Haemorrhage
TLDR
Intraventricular bleeding, hydrocephalus and basofrontal haematomas contribute to the pathogenesis of delirium, through damage to anatomical networks subserving sustained attention, declarative memory and the expression of emotional behaviour.
Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache
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In patients with acute severe headache, female sex, the presence of seizures, a history of loss of consciousness or focal symptoms, vomiting, or exertion increases the probability of ASAH, but these characteristics are of limited value in distinguishing ASAH from BTH.
Xanthochromia in the Cerebrospinal Fluid
TLDR
Any test must be sensitive enough to pick up cases of aneurysmal SAH and so allow timely intervention, but specific enough not to expose too many patients to the risk of unnecessary tests.
Acute hydrocephalus after aneurysmal subarachnoid hemorrhage.
Hydrocephalus, defined as a bicaudate index above the 95th percentile for age, was found in 34 (20%) of 174 prospectively studied patients with subarachnoid hemorrhage (SAH) who survived the first 24
Seizures at the onset of subarachnoid haemorrhage
TLDR
Although rebleeding and mortality or severe disability at discharge were more frequent in these patients, seizures were not a significant predictor of prognosis, and Hemiparesis, Hunt’s grade >3, the amount of subarachnoid blood and the presence of an aneurysm were significantly more frequent.
Acute confusional state as presenting feature in aneurysmal subarachnoid hemorrhage: frequency and characteristics
TLDR
Keys to early diagnosis of SAH in patients presenting with ACS are a preceding period of loss of consciousness and severe headache on neurological assessment, and one per 70 patients with SAH presents with ACS.
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