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Printable Handouts
Navigable Slide Index
- Introduction
- Subarachnoid hemorrhage (SAH)
- Etiology of spontaneous SAH
- Etiology of SAH
- Nonaneurysmal perimesencephalic SAH
- Nonaneurysmal PMSAH
- Diagnosing the causes of SAH
- Incidence of spontaneous SAH
- Epidemiology of aneurysms
- Risk factors for aneurysm formation and rupture
- Location of ruptured saccular aneurysms
- Outcome after aneurysmal SAH (1)
- Outcome after aneurysmal SAH (2)
- Prognosis for outcome after aneurysmal SAH
- Complications/time course
- Clinical grading scales
- Rebleeding
- Antifibrinolytic therapy
- International subarachnoid aneurysm trial
- Angiographic vasospasm (SAH) – prophylaxis
- Treatment of SAH
- Immediate effects of SAH
- Angiographic VSP – DCI
- Angiography – day 1
- Angiography – day 5
- Angiography – day 7
- Angiography – day 12
- Angiographic vasospasm – DCI
- Modified Fisher scale
- Guidelines – diagnosis of DCI (1)
- Guidelines – diagnosis of DCI (2)
- Transcranial Doppler ultrasound
- CTA and CTP (1)
- CTA and CTP (2)
- Guidelines – triggers for intervention
- Deterioration from DCI
- HIMALAIA trial
- Induced hypertension
- Mechanical/pharmacologic angioplasty (1)
- Mechanical/pharmacologic angioplasty (2)
- Magnesium
- Statins – SAH
- Lumbar drainage (1)
- Lumbar drainage (2)
- SAH management
- Deterioration – DCI (1)
- Deterioration – DCI (2)
- Disclosures
Topics Covered
- Etiology of subarachnoid haemorrhage (SAH)
- Diagnosing and incidence of SAH
- Epidemiology of aneurisms
- Clinical grading scales
- Outcome after aneurysmal SAH
- Immediate effects of SAH
- Treatment and management of SAH
- Diagnosis of delayed cerebral ischemia
- Computed tomography angiography/perfusion
- Management of SAH
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Talk Citation
Macdonald, R.L. (2020, April 29). Subarachnoid hemorrhage (SAH) [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 5, 2024, from https://doi.org/10.69645/LEDN4595.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Macdonald has the following financial relationships to disclose: Brain Aneurysm Foundation, Genome Canada Stockholder, board member in Edge Therapeutics, Inc. He also receives honararia from Idorsia Pharmaceuticals Ltd and Grace Bio-Labs.
A selection of talks on Clinical Practice
Transcript
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0:00
Hi, I'm Loch MacDonald.
I'm a professor of Neurosurgery at
the University of Toronto and I'm going to talk to you about Subarachnoid Hemorrhage.
0:11
Subarachnoid hemorrhage is characterized by
a very consistent clinical scenario of
sudden onset of the most severe headache of a person's life.
It's a pathological condition,
which you can see here on this CT scan on the left side,
which shows subarachnoid blood,
and in the picture of the base of the brain on the right from
a person who has subarachnoid hemorrhage and unfortunately hasn't survived.
0:41
So today we're talking about spontaneous subarachnoid hemorrhage.
Trauma, or anytime somebody is hit on the head can cause
subarachnoid bleeding just from the trauma and shaking of the brain,
and that's actually a common cause of subarachnoid hemorrhage,
but we're talking about the spontaneous cases where there's no trauma.
Causes of spontaneous subarachnoid hemorrhage,
if we take a circle and divide it into thirds,
you can see that two-thirds plus a half of the other third,
so about 85 percent of cases, are due to ruptured aneurysms,
which you can see on this CT angiogram,
the remaining 15 percent or so,
or half of a third are nonaneurysmal spontaneous subarachnoid hemorrhages.
1:29
Subarachnoid hemorrhage is a pathological condition,
it's bleeding in the subarachnoid space,
it's not a disease entity,
but a pathological condition due to multiple different causes.
As I said, for the spontaneous cases,
about 85 percent are aneurysmal,
of the remaining 15 percent,
about two-thirds of those are a specific condition called
nonaneurysmal perimesencephalic subarachnoid hemorrhage,
which used to be called benign perimesencephalic hemorrhage,
but the former term is preferable now.
The remaining five percent or so are due
to other causes like brain vascular malformations,
venous thrombosis, pituitary apoplexy, and coagulation disorders.