Abstract
The diagnosis of subarachnoid hemorrhage is typically made with CT; if CT is negative, usually a lumber puncture needs to be performed unless the CT is made within 6 h after onset of the hemorrhage and read by a staff radiologist. Once the diagnosis of subarachnoid hemorrhage has been made, the ruptured aneurysm is usually searched for by means of CT angiography. The most feared complication is rebleeding from the aneurysm, which has its highest peak in the initial hours after the hemorrhage. Currently, no therapy is available that can reduce this risk in the initial hours. If the patient has survived the initial hours and is admitted in a referral center, the aneurysm will usually be occluded early after admission by either coiling or clipping to prevent rebleeding during the clinical course; if both treatment options are technically feasible, coiling is the preferred option. Other neurological complications that can occur in the initial 1–2 weeks after the hemorrhage are delayed cerebral ischemia, for which treatment with oral nimodipine is the only effective preventive treatment, and hydrocephalus.
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References
Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Emond M, Symington C, et al. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ. 2011;343:d4277.
Backes D, Rinkel GJE, Kemperman H, Linn FH, Vergouwen MD. Time-dependent test characteristics of head computed tomography in patients suspected of nontraumatic subarachnoid hemorrhage. Stroke. 2012;43(8):2115–9.
Blok KM, Rinkel GJ, Majoie CB, Hendrikse J, Braaksma M, Tijssen CC, et al. CT within 6 hours of headache onset to rule out subarachnoid hemorrhage in nonacademic hospitals. Neurology. 2015 (Published online).
Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J. Xanthochromia after subarachnoid haemorrhage needs no re-visitation. J Neurol Neurosurg Psychiatry. 1989;52:826–8.
Westerlaan HE, van Dijk MJ, van Dijk MJ, Jansen-van der Weide MC, de Groot JC, Mooij JJ, et al. Intracranial Aneurysms in Patients with Subarachnoid Hemorrhage: CT Angiography as a primary examination tool for diagnosis – systematic review and meta-analysis. Radiology. 2011;258(1):134–45.
Yoon DY, Choi CS, Kim KH, Cho BM. Multidetector-row CT angiography of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: comparison of volume-rendered images and digital subtraction angiography. AJNR Am J Neuroradiol. 2006;27(2):370–7.
Agid R, Andersson T, Almqvist H, Willinsky RA, Lee SK, ter Brugge KG, et al. Negative CT angiography findings in patients with spontaneous subarachnoid hemorrhage: when is digital subtraction angiography still needed? AJNR Am J Neuroradiol. 2010;31(4):696–705.
Ruigrok YM, Rinkel GJE, Buskens E, Velthuis BK, van Gijn J. Perimesencephalic hemorrhage and CT angiography: a decision analysis. Stroke. 2000;31(12):2976–83.
Dorhout Mees SM, Rinkel GJE, Feigin V, Algra A, van den Bergh WM, Vermeulen M, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2007;(3):CD000277.
Germans MR, Coert BA, Vandertop WP, Verbaan D. Time intervals from subarachnoid hemorrhage to rebleed. J Neurol. 2014;261(7):1425–31.
Baharoglu MI, Germans MR, Rinkel GJE, Algra A, Vermeulen M, van Gijn J, et al. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2013;(8):CD001245.
Brilstra EH, Rinkel GJE, Algra A, van Gijn J. Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage. Neurology. 2000;55(11):1656–60.
Hop JW, Rinkel GJE, Algra A, van Gijn J. Initial loss of consciousness and risk of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Stroke. 1999;30(11):2268–71.
Rabinstein AA, Friedman JA, Weigand SD, McClelland RL, Fulgham JR, Manno EM, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2004;35(8):1862–6.
Vergouwen MD, Algra A, Rinkel GJE. Endothelin receptor antagonists for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis update. Stroke. 2012;43(10):3003–6.
Zwienenberg-Lee M, Hartman J, Rudisill N, Madden LK, Smith K, Eskridge J, et al. Effect of prophylactic transluminal balloon angioplasty on cerebral vasospasm and outcome in patients with Fisher grade III subarachnoid hemorrhage. Results of a phase II multicenter, randomized, clinical trial. Stroke. 2008;39(6):1759–65.
Vergouwen MD, Vermeulen M, Coert BA, Stroes ES, Roos YB. Microthrombosis after aneurysmal subarachnoid hemorrhage: an additional explanation for delayed cerebral ischemia. J Cereb Blood Flow Metab. 2008;28(11):1761–70.
Dankbaar JW, Slooter AJ, Rinkel GJE, van der Schaaf I. Effect of different components of triple-H therapy on cerebral perfusion in patients with aneurysmal subarachnoid haemorrhage: a systematic review. Crit Care. 2010;14(1):R23.
Amin-Hanjani S, Schwartz RB, Sathi S, Stieg PE. Hypertensive encephalopathy as a complication of hyperdynamic therapy for vasospasm: report of two cases. Neurosurgery. 1999;44(5):1113–6.
Wartenberg KE, Parra A. CT and CT-perfusion findings of reversible leukoencephalopathy during triple-H therapy for symptomatic subarachnoid hemorrhage-related vasospasm. J Neuroimaging. 2006;16(2):170–5.
Brilstra EH, Algra A, Rinkel GJE, Tulleken CAF, van Gijn J. Effectiveness of neurosurgical clip application in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2002;97(5):1036–41.
Brilstra EH, Rinkel GJE, van der Graaf Y, van Rooij WJJ, Algra A. Treatment of intracranial aneurysms by embolization with coils: a systematic review. Stroke. 1999;30(2):470–6.
Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT). Lancet. 2014;28.
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Rinkel, G.J.E., Greebe, P. (2015). In Hospital Course. In: Subarachnoid Hemorrhage in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-17840-0_4
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DOI: https://doi.org/10.1007/978-3-319-17840-0_4
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