Subarachnoid hemorrhage: implications and treatment
Subarachnoid hemorrhage (SAH) is nothing like the outpouring and accumulation of blood in the subarachnoid space of the brain or spinal cord. Can occur as a result of the trauma and in acute disorders of cerebral circulation. In the first case the hemorrhage is called traumatic, and the second spontaneous.
Upon the occurrence of SAH, the patient is experiencing an acute headache. In some cases, possible pain shock and loss of consciousness. Subarachnoid hemorrhage requires immediate treatment to avoid death. Therapy, usually performed in neurosurgery.
The reasons for the SAK
Most often (in 80% of cases) cause of subarachnoid hemorrhage are aneurysm. They are stretched due to violation of the elasticity and form bags with subtle walls. In moments of sharp increase in blood pressure tissue does not withstand the load and breaks. Blood enters into the subarachnoid space from which it cannot be removed naturally.
Oddly enough, rupture of the aneurysm in more than 90 % of cases occur in people aged 25 to 50 years. Older people from this disease suffer very rarely. Among the most common causes that trigger the onset of a SAH include:
- vasculitis, vasculopathy;
- arteriitis (fungal and infectious types);
- diabetic angiopathy;
- the thrombocytopathy;
- hemorrhagic diathesis;
- the hemangioma.
When the predisposition to hemorrhage in the brain becomes severe, it can occur in the process:
- heavy lifting;
- severe coughing;
- difficult defecation;
- long-term stress.
The patient becomes sensitive to pressure and can be affected by SAC, even in times of increasing physical activity. Unfortunately, about 10 % of cases to determine the cause of bleeding in the brain is not possible. There are cases when specialists could not find the cause of the disease even after the autopsy.
The exception to this rule is traumatic subarachnoid hemorrhage. It occurs due to shock or other types of physical impact. In most cases, it affects young people most often injured in the process:
- falls from height;
- traffic accidents;
- conflicts and fights.
The symptoms occurred while the NAO may not be felt for several days. After this, the patient may begin to experience severe headaches and pain in the spine (where the spinal cord is located). To save him in this case can only hospitalization and the help of neurosurgeons.
There are cases when subarachnoid hemorrhage affects newborns. The reason for this, usually, is birth trauma. Infants SAK characterized by the following symptoms:
- brain Creek;
- inflammation of the fontanelles and suture;
- sleep disorders;
- increased activity, restlessness.
The first symptoms manifest themselves a day after the birth and make themselves known by increasing. In cases where hemorrhage is moderate, the child easy to treat. In patients with severe SAH, the risk of death increases.
In the development of the disease distinguish two periods: lovemarriage and hemorrhagic. Each of them characterized by certain symptoms which need to be discussed in detail. So, during lovemarriage period, the patient experiences:
- pain in the forehead and eye sockets;
- the decrease in visual acuity.
- a hemifacial spasm.
In severe cases, it is also possible the likelihood of an epileptic seizure.
After rupture of the aneurysm occurs hemorrhagic period. It is characterized by the following features:
- sharp, continuing headache;
- an increase in temperature;
- nausea and vomiting;
- a cardiac rhythm;
- a decrease in respiratory rate;
- dizziness and lightheadedness condition.
If subarachnoid hemorrhage is not treated on time, the consequences can be very serious. The primary symptoms can escalate into the following pathologies:
- a speech disorder;
- blurred vision;
- memory loss;
- mental disorder.
Subarachnoid hemorrhage is easily diagnosed using a lumbar puncture. Flows in the subarachnoid space blood six hours and more changes its color. This allows you to easily determine the location of aneurysm rupture and begin to address the crisis. As additional diagnostic tools can also be used:
- cerebral angiography;
- magnetic resonance imaging.
For example, the latter allows to detect the aneurysm before bleeding, if their diameter exceeds 3 mm. During the diagnostic specialists, as a rule, examined all four major cerebral artery. Often aneurysms do not develop in one but in several places at the same time. That is why the creation of a coherent picture is so important in the survey.
Subarachnoid hemorrhage requires immediate treatment in the clinic. Following an examination by the neurosurgeon of the patient, as a rule, subjected to medical therapy. It uses medicines fast action, intended for normalization of arterial blood and intracranial pressure. In cases where the patient is unconscious, all manipulations are carried out using the system of artificial ventilation of lungs. It should be noted that measures to eliminate the consequences of the NAO is very similar to therapy in stroke.
Surgery when bleeding in the brain requires the prior preparation process. The patient is subjected to angiography of the GM, and further actions are performed only by its results. In cases when the patient’s condition allows it, surgery is appointed in the first two or three days after the onset of the crisis.
If the aneurysm has a massive character, brain surgery is contraindicated until the expiration of the period of two weeks. During this time occurs the so-called «cold period», and surgery can be performed with minimal risk for the patient. During the entire time when the patient is in the hospital, he is exposed to drug effects. This allows you to slow the development of pathology and to keep it alive until the operation.
The consequences SAK
Even with timely treatment of subarachnoid hemorrhage entails very negative consequences. The patient has to take antifibrinolytic drugs preventing the re-occurrence of a SAK. In addition, some symptoms may still occur even after a course of rehabilitation. So, due to continued arterial hypertension the patient may be assigned to antihypertensive therapy. In the absence of massive lesions from the SAC, it usually does not last long. Despite these apparent tissue damage, the treatment may take several months or even years.
Implications of cerebral vessels after SAH can be dire. So, about half of patients who have experienced subarachnoid hemorrhage, there is a predisposition to stroke. A quarter of all the operated patients become disabled and often lose the ability to speak coherently in words. There have been other neurological disorders. For example, the consequences for survivors SAK medium gravity, may be in violation of the locomotor apparatus. The person experiences all characteristic of this condition the symptoms and can only move with assistance.
Statistics show that only one person out of six has a chance of recovery after SAH. All other migrated crisis has consequences of varying severity. So, premature death occurs in approximately 40-50 % of patients who survived surgery. All of them, usually the rest of your life suffering from high blood pressure and susceptibility to heart attack.
It is also worth noting that after a brain hemorrhage, the patient is strictly contraindicated excessive physical activity. About any sports and heavy physical labor after the surgery can not walk and talk. In addition, after the crisis the patient must significantly change your diet and permanently give up bad habits. Otherwise, the situation could be repeated a second time with a probability of 80 % and above will lead to death.