Subarachnoid Hemorrhage Questions & Answers

Updated: Dec 07, 2018
  • Author: Tibor Becske, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Questions & Answers

Overview

What is subarachnoid hemorrhage (SAH)?

What are the signs and symptoms of subarachnoid hemorrhage (SAH)?

Which signs may be present prior to subarachnoid hemorrhage (SAH)?

What causes prodromal signs and symptoms of subarachnoid hemorrhage (SAH)?

What is the classic presentation of subarachnoid hemorrhage (SAH)?

Which physical findings are characteristic of subarachnoid hemorrhage (SAH)?

What are the possible complications of subarachnoid hemorrhage (SAH)?

How is subarachnoid hemorrhage (SAH) diagnosed?

Which lab studies are used in the diagnosis of subarachnoid hemorrhage (SAH)?

Which imaging studies are used in the diagnosis of subarachnoid hemorrhage (SAH)?

Which diagnostic studies may be helpful in the diagnosis of subarachnoid hemorrhage (SAH)?

What are the treatment options for subarachnoid hemorrhage (SAH)?

Which interventions are used to increase intracranial pressure (ICP) during subarachnoid hemorrhage (SAH)?

What are common complications of subarachnoid hemorrhage (SAH)?

What are the surgical options for subarachnoid hemorrhage (SAH)?

What are the screening recommendations for subarachnoid hemorrhage (SAH)?

What is subarachnoid hemorrhage (SAH)?

What is the most common etiology of nontraumatic subarachnoid hemorrhage (SAH)?

What is the incidence of strokes caused by subarachnoid hemorrhage (SAH)?

How is subarachnoid hemorrhage (SAH) diagnosed?

How is subarachnoid hemorrhage (SAH) treated?

What is the role of aneurysm in the pathogenesis of subarachnoid hemorrhage (SAH)?

What is the probability of aneurysm rupture in the pathogenesis of subarachnoid hemorrhage (SAH)?

What is the role of hypertension in the pathogenesis of subarachnoid hemorrhage (SAH)?

What causes brain injury in subarachnoid hemorrhage (SAH)?

What occurs following aneurysm ruptures in the pathogenesis of subarachnoid hemorrhage (SAH)?

Which conditions are positively correlated with the formation of saccular aneurysms?

What is an indicator of vascular factors in the formation of aneurysms?

What are the risk factors for berry aneurysms?

What are possible complications of subarachnoid hemorrhage (SAH)?

How does subarachnoid hemorrhage (SAH) cause hydrocephalus?

What are risk factors for subarachnoid hemorrhage (SAH)?

What is the prevalence of rebleeding in subarachnoid hemorrhage (SAH)?

How does delayed cerebral ischemia affect the prognosis of subarachnoid hemorrhage (SAH)?

What is the role of intracerebral hemorrhage (ICH) in subarachnoid hemorrhage (SAH)?

What are the sources of intraventricular hemorrhage (IVH) in subarachnoid hemorrhage (SAH)?

What is the role of left ventricle (LV) systolic dysfunction in subarachnoid hemorrhage (SAH)?

What is the role of subdural hematoma (SDH) in subarachnoid hemorrhage (SAH)?

What is the role of increased intracranial pressure (ICP) in subarachnoid hemorrhage (SAH)?

What causes subarachnoid hemorrhage (SAH)?

What is the etiologic relationship between intraparenchymal hematoma and subarachnoid hemorrhage (SAH)?

What is the evidence for congenital causes of subarachnoid hemorrhage (SAH)?

What is the role of arteriovenous malformations (AVMs) in the pathogenesis of subarachnoid hemorrhage (SAH)?

What are acquired etiological factors of subarachnoid hemorrhage (SAH)?

What are less common causes of subarachnoid hemorrhage (SAH)?

What is the role of reversible cerebral vasoconstriction syndrome (RCVS) in the etiology of subarachnoid hemorrhage (SAH)?

What are the risk factors for subarachnoid hemorrhage (SAH)?

What do not appear to be significant risk factors for subarachnoid hemorrhage (SAH)?

What is the prevalence of subarachnoid hemorrhage (SAH) in the US?

What is the annual incidence of subarachnoid hemorrhage (SAH) in the US?

What is the global incidence of subarachnoid hemorrhage (SAH)?

What is the incidence of subarachnoid hemorrhage (SAH) in Japan?

What is the incidence of subarachnoid hemorrhage (SAH) in Australia?

What is the incidence of subarachnoid hemorrhage (SAH) in Iceland?

What is the incidence of subarachnoid hemorrhage (SAH) in China?

What are the racial predilections of subarachnoid hemorrhage (SAH)?

How does the incidence of subarachnoid hemorrhage (SAH) vary by sex?

How does the incidence of subarachnoid hemorrhage (SAH) vary by age?

What are the mortality rates for subarachnoid hemorrhage (SAH)?

What are the age-adjusted mortality rates for subarachnoid hemorrhage (SAH)?

What is the prevalence of neurologic deficits in patients with subarachnoid hemorrhage (SAH)?

Which factors affect morbidity and mortality rates for subarachnoid hemorrhage (SAH)?

What are factors that affect the prognosis of subarachnoid hemorrhage (SAH)?

How does acute cocaine use affect the prognosis of subarachnoid hemorrhage (SAH)?

Which grading scales are used for the clinical assessment of subarachnoid hemorrhage (SAH)?

What is the World Federation of Neurological Surgeons (WFNS) scale for the clinical assessment of subarachnoid hemorrhage (SAH)?

What is the Fisher scale for the clinical assessment of subarachnoid hemorrhage (SAH)?

What is the Hunt and Hess grading system for the clinical assessment of subarachnoid hemorrhage (SAH)?

How do survival rates for subarachnoid hemorrhage (SAH) vary by grade?

What is the efficacy of the grading systems used to clinically assess subarachnoid hemorrhage (SAH)?

What are the possible complications of subarachnoid hemorrhage (SAH)?

What is the incidence of rebleeding in subarachnoid hemorrhage (SAH)?

What is the most common cause of death and disability in subarachnoid hemorrhage (SAH)?

How does intraventricular hemorrhage (IVH) affect the prognosis of subarachnoid hemorrhage (SAH)?

Presentation

What are the signs and symptoms of subarachnoid hemorrhage (SAH)?

What are the most common symptoms of subarachnoid hemorrhage (SAH)?

What signs are present prior to subarachnoid hemorrhage (SAH)?

What causes the prodromal signs and symptoms of subarachnoid hemorrhage (SAH)?

What are the signs and symptoms of sentinel leaks in subarachnoid hemorrhage (SAH)?

How does aneurysm location affect the presentation of subarachnoid hemorrhage (SAH)?

What are symptoms of emboli in subarachnoid hemorrhage (SAH)?

What is the central feature of classic subarachnoid hemorrhage (SAH)?

What are the symptoms of meningeal irritation in subarachnoid hemorrhage (SAH)?

What are characteristics of loss of consciousness (LOC) in subarachnoid hemorrhage (SAH)?

What are characteristics of seizures in subarachnoid hemorrhage (SAH)?

What are the high-risk characteristics associated with subarachnoid hemorrhage (SAH)?

When should subarachnoid hemorrhage (SAH) be investigated?

What is the frequency of subarachnoid hemorrhage (SAH) in patients who are at rest?

What are the physical findings in subarachnoid hemorrhage (SAH)?

Which funduscopy findings suggest subarachnoid hemorrhage (SAH)?

How common are neurologic abnormalities in subarachnoid hemorrhage (SAH)?

Which grading scales are used for the clinical assessment of subarachnoid hemorrhage (SAH)?

What is the World Federation of Neurological Surgeons (WFNS) scale for the clinical assessment of subarachnoid hemorrhage (SAH)?

What is the Fisher scale for the clinical assessment of subarachnoid hemorrhage (SAH)?

What is the Hunt and Hess grading system for the clinical assessment of subarachnoid hemorrhage (SAH)?

How is the grade of subarachnoid hemorrhage (SAH) significant?

What is the efficacy of the grading systems used to clinically assess subarachnoid hemorrhage (SAH)?

What are complications of subarachnoid hemorrhage (SAH)?

What are characteristics of hydrocephalus in subarachnoid hemorrhage (SAH)?

What are characteristics of acute hydrocephalus in subarachnoid hemorrhage (SAH)?

What are characteristics of late or chronic hydrocephalus in subarachnoid hemorrhage (SAH)?

What are the risk factors for rebleeding in patients with subarachnoid hemorrhage (SAH)?

What is the leading cause of death and disability in with subarachnoid hemorrhage (SAH)?

What are risk factors for vasospasm in subarachnoid hemorrhage (SAH)?

What are the symptoms of vasospasm in subarachnoid hemorrhage (SAH)?

What is incidence of vasospasm in subarachnoid hemorrhage (SAH)?

What is the definitive imaging study for diagnosis of vasospasm in subarachnoid hemorrhage (SAH)?

Which imaging modalities may be useful for the evaluation of vasospasm in subarachnoid hemorrhage (SAH)?

How common are seizures in subarachnoid hemorrhage (SAH)?

What are the symptoms of cardiac dysfunction in subarachnoid hemorrhage (SAH)?

What is the prevalence of arrhythmias in subarachnoid hemorrhage (SAH)?

DDX

How should headache be evaluated in suspected subarachnoid hemorrhage (SAH)?

What are the differential diagnoses for Subarachnoid Hemorrhage?

Workup

How is subarachnoid hemorrhage (SAH) diagnosed?

What is the role of CT scanning in the diagnosis of subarachnoid hemorrhage (SAH)?

Why are further imaging studies needed following a diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of lab studies in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of serum cardiac troponin measurement in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of chest radiography in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of electrocardiogram (ECG) in the diagnosis of subarachnoid hemorrhage (SAH)?

Which imaging studies may be indicated in the diagnosis of subarachnoid hemorrhage (SAH)?

How is CT scanning used for the diagnosis of subarachnoid hemorrhage (SAH)?

What causes a falsely negative CT finding in subarachnoid hemorrhage (SAH)?

What is the significance of the blood location in subarachnoid hemorrhage (SAH)?

Where do intraparenchymal hemorrhages occur in subarachnoid hemorrhage (SAH)?

What is the role of contrast-enhanced CT scanning in the diagnosis of subarachnoid hemorrhage (SAH)?

What are the classifications of subarachnoid hemorrhage (SAH) by the Fisher grading system?

What is the appearance on CT scans of hydrocephalus in subarachnoid hemorrhage (SAH)?

What is the role of infusion CT scanning in the diagnosis of subarachnoid hemorrhage (SAH)?

When is lumbar puncture (LP) indicated for the diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of lumbar puncture (LP) in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the significance of red blood cell (RBC) in CSF in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the significance of a finding of xanthochromia in subarachnoid hemorrhage (SAH)?

What is the role of D-dimer assay in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the significance of negative findings from LP for subarachnoid hemorrhage (SAH)?

What is the role of digital-subtraction cerebral angiography in the diagnosis of subarachnoid hemorrhage (SAH)?

What information about subarachnoid hemorrhage (SAH) can be provided by cerebral angiography?

What is the role of trial balloon occlusion in the evaluation of subarachnoid hemorrhage (SAH)?

What is the significance of negative angiographic findings in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the purpose of follow-up angiography following a diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of MD-CTA in the diagnosis of subarachnoid hemorrhage (SAH)?

What are the advantages of MD-CTA in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of MRI in the diagnosis of subarachnoid hemorrhage (SAH)?

When is MRI used in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of MRA in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of chest radiography in the diagnosis of subarachnoid hemorrhage (SAH)?

What is the role of electrocardiogram (ECG) in the diagnosis of subarachnoid hemorrhage (SAH)?

Which electrocardiogram (ECG) abnormalities suggest subarachnoid hemorrhage (SAH)?

Treatment

What is the traditional treatment for subarachnoid hemorrhage (SAH)?

What are the current treatment recommendations for subarachnoid hemorrhage (SAH)?

Which substances are typically avoided in the treatment of subarachnoid hemorrhage (SAH)?

What is the treatment for increased intracranial pressure (ICP) or herniation in subarachnoid hemorrhage (SAH)?

What are treatment options for increased intracranial pressure (ICP) due to subarachnoid hemorrhage (SAH)?

When is admission to the ICU indicated in the treatment of subarachnoid hemorrhage (SAH)?

Which complications of subarachnoid hemorrhage (SAH) requires additional medical management?

What is the ideal setting for treatment of complications of subarachnoid hemorrhage (SAH)?

Why is maintain blood pressure below 130-140 mm Hg necessary during treatment of subarachnoid hemorrhage (SAH)?

How is blood pressure maintained in patients with subarachnoid hemorrhage (SAH)?

What are the surgical treatments used for subarachnoid hemorrhage (SAH)?

What is the initial management of subarachnoid hemorrhage (SAH)?

Which treatment techniques can be used to blunt an increase in intracranial pressure (ICP) in subarachnoid hemorrhage (SAH)?

What should be monitored during initial management of subarachnoid hemorrhage (SAH)?

What is the prognosis of rebleeding in subarachnoid hemorrhage (SAH) and how is rebleeding prevented?

What are treatment options for rebleeding in subarachnoid hemorrhage (SAH)?

What are the surgical treatments used to prevent rebleeding in subarachnoid hemorrhage (SAH)?

What is the basis for surgical technique selection in the treatment of subarachnoid hemorrhage (SAH)?

What is the role for coiling in the surgical treatment of subarachnoid hemorrhage (SAH)?

What are possible adverse effects of coiling for the treatment of subarachnoid hemorrhage (SAH)?

What are investigational treatments for subarachnoid hemorrhage (SAH)?

What are the differences in safety and efficacy between stent-assisted coiling (SAC) and balloon assisted coiling (BAC)?

What is the preferred timing for surgical intervention to treat subarachnoid hemorrhage (SAH)?

When is early surgery or coiling recommended for the treatment of subarachnoid hemorrhage (SAH)?

When is delayed surgical intervention recommended for the treatment of subarachnoid hemorrhage (SAH)?

How is vasospasm prevented in subarachnoid hemorrhage (SAH)?

What is the role of nimodipine in the treatment of subarachnoid hemorrhage (SAH)?

How does nimodipine protect against vasospasm in subarachnoid hemorrhage (SAH)?

How is nimodipine administered in the treatment of subarachnoid hemorrhage (SAH)?

What is the role of thrombolytic therapy in the treatment of subarachnoid hemorrhage (SAH)?

What is the role of aspiration and irrigation in the treatment of subarachnoid hemorrhage (SAH)?

What is the role of CSF drainage in the treatment of subarachnoid hemorrhage (SAH)?

What is the role of statins in treatment of subarachnoid hemorrhage (SAH)?

What is the role of triple H therapy in the treatment of subarachnoid hemorrhage (SAH)?

What is the efficacy of the triple H therapy for treatment of vasospasms in subarachnoid hemorrhage (SAH)?

What is aggressive hypertensive therapy for the treatment of vasospasms in subarachnoid hemorrhage (SAH)?

What is required for the initiation of triple H therapy for subarachnoid hemorrhage (SAH)?

What is the role of transluminal balloon angioplasty in the treatment of subarachnoid hemorrhage (SAH)?

What is the role of papaverine in the treatment of subarachnoid hemorrhage (SAH)?

What is the role of magnesium in the treatment of subarachnoid hemorrhage (SAH)?

What are some investigational agents for the treatment of vasospasms in subarachnoid hemorrhage (SAH)?

What is the treatment for acute hydrocephalus in subarachnoid hemorrhage (SAH)?

What are the treatment options for symptomatic hydrocephalus in subarachnoid hemorrhage (SAH)?

What is the efficacy of ventriculostomy for the treatment of hydrocephalus in subarachnoid hemorrhage (SAH)?

What should be considered when grading subarachnoid hemorrhage (SAH) in patients with hydrocephalus?

What is the prevalence of hyponatremia in subarachnoid hemorrhage (SAH)?

How is hyponatremia treated in subarachnoid hemorrhage (SAH)?

Which agents are used for seizure prophylaxis in subarachnoid hemorrhage (SAH)?

What is the role of anticonvulsant therapy in the treatment of subarachnoid hemorrhage (SAH)?

What are characteristics of acute pulmonary edema in subarachnoid hemorrhage (SAH)?

What are characteristics of hypoxemia induced by subarachnoid hemorrhage (SAH)?

What is the treatment for acute pulmonary edema in subarachnoid hemorrhage (SAH)?

What are characteristics of cardiac dysfunction in subarachnoid hemorrhage (SAH)?

What should be considered prior to treatment of cardiac dysfunction in subarachnoid hemorrhage (SAH)?

Who should be screened for subarachnoid hemorrhage (SAH)?

Medications

What are the goals of treatment in patients with subarachnoid hemorrhage (SAH)?

What are the medications used in the treatment of subarachnoid hemorrhage (SAH)?

Which medications in the drug class Anxiolytics, Benzodiazepines are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class General Anesthetics, Systemic are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Hemostatics are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Diuretics, Loop are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Diuretics, Osmotic Agents are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Antiemetic Agents are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Beta-Blockers, Alpha Activity are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Stool Softeners are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Anticonvulsants, Other are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Calcium Channel Blockers are used in the treatment of Subarachnoid Hemorrhage?

Which medications in the drug class Opioid Analgesics are used in the treatment of Subarachnoid Hemorrhage?