Hemorrhage, subarachnoid

History of intracranial hemorrhage or symptoms suspicious for subarachnoid hemorrhage Major surgery within past 14 days ... 

Parra A, Kreiter KT, Williams S, Sciacca R, Mack WJ, Naidech AM, Commichau CS, Fitzsimmons BF, Janjua N, Mayer SA, Connolly Jr. ES, Effect of prior statin use on functional outcome and delayed vasospasm after acute aneurysmal subarachnoid hemorrhage a matched controlled cohort study. Neurosurgery 2005 56 476 84 [discussion 476 84]. 

Tseng MY, Czosnyka M, Richards H, Pickard JD, Kirkpatrick PJ. Effects of acute treatment with pravastatin on cerebral vasospasm, autoregulation, and delayed ischemic deficits after aneurysmal subarachnoid hemorrhage a phase II randomized placebo-controlled trial. Stroke 2005 36 1627-1632. 

Singhal AB, Topcuoglu MA, Dorer DJ, Ogilvy CS, Carter BS, Koroshetz WJ. Ssri and statin use increases the risk for vasospasm after subarachnoid hemorrhage. Neurology 2005 64 1008-1013. 

Dissection of the internal carotid and vertebral arteries is a common cause of stroke, particularly in young patients. Although many occur due to trauma, it is estimated that over half occur spontaneously. The mechanism of stroke following arterial dissection is either by artery-to-artery embolism, by thrombosis in situ, or by dissection-induced lumenal stenosis with secondary cerebral hypoperfusion and low-flow watershed infarction. Occasionally, dissection may lead to the formation of a pseudoaneurysm as a source of thrombus formation. Vertebrobasilar dissections that extend intracranially have a higher risk of rupture leading to subarachnoid hemorrhage (SAH). ° ... 

Endo S, Nishijima M, Nomura H, Takaku A, Okada E. A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage report of three autopsied cases and review of the literature. Neurosurgery 1993 33 732-738. 

Wartenberg KE, Schmidt JM, Claassen J, Temes RE, Frontera JA, Ostapkovich N, Parra A, Connolly ES, Mayer SA. Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 2006 34(3) 617-623. 

Oliveira-Filho J, Ezzedine MA, Segal AZ, Buonanno FS, Chang Y, Ogilvy CS, Rordorf G, Schwamm LH, Koroshetz WJ, McDonald CT. Fever in subarachnoid hemorrhage relationship to vasospasm and outcome. Neurology 2001 56(10) 1299-1304. 

Kassell, N.F., Haley, E.C., Halves, W.M., Hunsen, C.A. and Weir, B. (1993). Phase two trial of tirilazad in aneurysmal subarachnoid hemorrhage. Vth International Symposium on Cerebral Vasospasm, Edmonton and Jasper, Alberta, Canada, May 18-21. Can. J. Neurol. Sci. 20, S29. 

Evidence of intracranial hemorrhage, subarachnoid hemorrhage, or a large area of cerebral edema, parenchymal hypodensities, or sulcal effacement on pretreatment CT scan... 

Cerebrovascular accident (CVA), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), central nervous system (CNS) tumor, head trauma, CNS infection, and pre-eclampsia/eclampsia... 

Hemorrhagic stroke is a result of bleeding into the brain and other spaces within the central nervous system and includes subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hematomas. 

There is no proven treatment for intracerebral hemorrhage. Management is based on neurointensive care treatment and prevention of complications. Oral nimodipine is recommended in subarachnoid hemorrhage to prevent delayed cerebral ischemia. 

Clinical presentation suggestive of subarachnoid hemorrhage even with a normal head CT... 

Oral nimodipine is recommended in subarachnoid hemorrhage to prevent delayed cerebral ischemia. Delayed cerebral ischemia occurs 4 to 14 days after the initial aneurysm rupture and is a common cause of neurologic deficits and death. A meta-analysis of 12 studies was conducted and concluded that oral nimodipine 60 mg every 4 hours for 21 days following aneurysmal SAH reduced the risk of a poor outcome and delayed cerebral ischemia.40... 

ASA, aspirin BP, blood pressure Hb, hemoglobin Hct, hematocrit ICP, intracranial pressure ICU, intensive care unit INR, International Normalized Ratio SAH, subarachnoid hemorrhage t-PA, tissue plasminogen activator. 

Mase, M., et al. (1999). Acute and transient increase of lipocalin-type prostaglandin D synthase (beta-trace) level in cerebrospinal fluid of patients with aneurysmal subarachnoid hemorrhage. Neurosci. Lett. 270, 188-90. 

Suggested Alternatives for Differential Diagnosis Abdominal aneurysm, aortic dissection, pleural effusion, subarachnoid hemorrhage, superior vena cava syndrome, hantavirus pulmonary syndrome, mediastinitis, fulminate mediastinal tumors pneumonia, gastroenteritis, meningitis, ecthyma, rat bite fever, spider bite, leprosy, plague, tularemia, coccidioidomycosis, diphtheria, glanders, histoplasmosis, psittacosis, typhoid fever, and rickettsial pox. 

A number of toxic conditions beside hypoosmotic stress and hypoxia/ischemia produce brain edema and the causes may be related to regulation of the aquaporins (see Ch. 34). AQP1 and AQP4 are intensely upregulated in reactive astrocytes in subarachnoid hemorrhage [69], in human glioma and astrocytoma [70] and AQP4 in endothelia and reactive astrocytes in metastatic carcinoma [71,72]. 

Badaut, J., Brunet, J. F., Grollimund, L. etal. Aquaporin 1 and aquaporin 4 expression in human brain after subarachnoid hemorrhage and in peritumoral tissue. Acta Neurochir. 86(Suppl) 495-8, 2003. 

Hemorrhagic strokes account for 12% of strokes and include subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hematomas. Subarachnoid hemorrhage may result from trauma or rupture of an intracranial aneurysm or arteriovenous malformation. Intracerebral hemorrhage occurs when a ruptured blood vessel within the brain parenchyma causes formation of a hematoma. Subdural hematomas are most often caused by trauma. 

In subarachnoid hemorrhage due to a ruptured intracranial aneurysm or arteriovenous malformation, surgical intervention to clip or ablate the vascular abnormality substantially reduces mortality from rebleeding. The benefits of surgery are less well documented in cases of primary intracerebral hemorrhage. In patients with intracerebral hematomas, insertion of an intraventricular drain with monitoring of intracranial pressure is... 

Increase in TXA2 synthesis at 5 min and 1 week of reperfusion suggests role in acute events and later stages of neurological dysfunction (Shohami et al., 1987). TXA2 synthetase inhibitor decreases vasospasm and reduces neurological deterioration after subarachnoid hemorrhage (Tokiyoshi et al., 1991). 

HETE affects cerebral blood flow after subarachnoid hemorrhage in rats (Kehl et al., 2002 Miyata et al., 2005). 

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