Subarachnoid Hemorrhage Information - symptom, cause, treatment of
Subarachnoid Hemorrhage Information
Between 5% and 10% of strokes are due to subarachnoid hemorrhage. Although hemorrhage is usually from rupture of an aneurysm or arteriovenous malformation, no specific cause can be found in 20% of cases.
Symptoms and Signs of Subarachnoid Hemorrhage
Subarachnoid hemorrhage has a characteristic clinical picture. Its onset is with sudden headache of a severity never experienced previously by the patient. This may be followed by nausea and vomiting and by a loss or impairment of consciousness that can either be transient or progress inexorably to deepening coma and death. If consciousness is regained, the patient is often confused and irritable and may show other symptoms of an altered mental status. Neurologic examination generally reveals nuchal rigidity and other signs of meningeal irritation, except in deeply comatose patients. A focal neurologic deficit is occasionally present and may suggest the site of the underlying lesion.
Treatment of Subarachnoid Hemorrhage
The measures outlined below in the section on stupor and coma are applied to comatose patients. Conscious patients are confined to bed, advised against any exertion or straining, treated symptomatically for headache and anxiety, and given laxatives or stool softeners. If there is severe hypertension, the blood pressure can be lowered gradually, but not below a diastolic level of 100 mm Hg. Phenytoin is generally prescribed routinely to prevent seizures. Further comment concerning the specific operative management of arteriovenous malformations and aneurysms follows.