Why develop and how does subarachnoid hemorrhage manifest?

1 Hemorrhage under the spider web

The human brain is very complicated. It consists of a parenchyma and membranes. There are only 3 of them: soft, spidery and firm. A soft shell covers all the gyrus and penetrates into the furrows. It has many vessels. The web is more delicate and does not enter the furrows.

Subarachnoid hemorrhage is an acute disorder of the cerebral circulation, in which blood leaves the blood vessels and accumulates in the space under the arachnoid membrane. At the heart of the development of this pathology is the damage of blood vessels. In the general structure of acute disturbance of cerebral blood flow, this disease accounts for up to 10%.The incidence rate is 6-12 cases per 100 thousand xtkjdtr population per year.

The prevalence of this pathology varies from 5 to 7%.The risk group includes men aged 45 to 60 years. About 15% of the victims die before medical assistance and hospitalization. On the first day of the onset of symptoms, one out of every four people dies. In 7 days the percentage of death is 50%.

2 Classification of ASA

Subarachnoid hemorrhage is divided into traumatic and spontaneous hemorrhage. In the first case, it is caused by a craniocerebral trauma( brain injury) with mechanical damage( rupture) of the vessels. Traumatologists face a similar problem. The spontaneous form differs in that it develops with whole blood vessels. The cause may be an infection or a congenital anomaly of the development of the brain or blood vessels.

There are also isolated or combined hemorrhage. In the first case, blood accumulates only in 1 area. In the second - subarachnoid space, ventricles and parenchyma can be affected simultaneously. Depending on the volume of accumulated blood, there are 4 classes of this disease.

Class 1 is characterized by a lack of blood according to the results of computed tomography. At grade 2, the thickness of the blood layer is up to 1 mm, with no clots being detected. Class 3 is installed in the case if the SAK has a thickness of more than 1 mm with the presence of clots. In grade 4, the parenchyma of the brain, as well as the ventricular tissue, suffers.

3 Basic etiological factors

Subarachnoid hemorrhage is caused by various factors. The following causes of this acute disturbance of cerebral circulation distinguish:

• aneurysm rupture;
• hypertension;
• craniocereberal trauma;
• stratification of the vertebral artery;
• heart tumor( myxoma);
• of the brain tumor;
• vasculitis;
• vascular lesions against amyloidosis;
• sickle cell anemia;
• prolonged use of anticoagulants;
• presence of atherosclerosis of cerebral vessels.

Not always the cause of hemorrhage can be identified. In most patients, acute cerebrovascular accident is due to an aneurysm. It is a protrusion of the artery wall. This pathology is congenital and acquired. The risk of aneurysm rupture during life is 10-30%.

The cause may be a genetic abnormality( phacomatosis, Marfan syndrome, coarctation aorta, polycystic kidney disease).An aneurysm is almost always formed against a background of high blood pressure. The risk of developing an aneurysm increases when a person has bacterial endocarditis, fungal diseases and meningitis. The gap is possible against a background of stress, severe overstrain, physical activity, hypertensive crisis. Provoke this complication may be strong attempts.

Post-traumatic subarachnoid hemorrhage is most often associated with head trauma.

This may be a fracture of the bones, bruising or squeezing. A bruised brain injury with vascular damage is caused by an industrial, domestic or sports injury. The risk factors include non-observance of the rules of labor protection, lack of personal protective equipment( helmets, helmets), lack of insurance, stay in a state of intoxication, work at height, and engage in extreme sports.

Hemorrhage in the brain is possible with the intentional infliction of harm to a person or during a fight. Blows to the head and falls on a hard surface can lead to damage to blood vessels. Often, hemorrhage is observed in newborns when passing a baby through a narrow pelvis or with an improperly performed obstetric manual. The risk factors for hemorrhage include smoking, atherosclerosis, malnutrition, stress, weighed heredity, drug dependence, syphilis, alcoholism, blood diseases, beriberi.

4 Clinical signs of defeat

Symptoms of hemorrhage under the arachnoid membrane are always very pronounced. This urgent condition is manifested by the following symptoms:

• very severe headache;
• by dizziness;
• with nausea;
• symptoms of trigeminal nerve injury;
• oculomotor disorders;
• aphasia;
• decreased vision.

Subarachnoid hemorrhage is acute. It all starts with a painful headache. It has the following features:

• is very intense;
• shooting or pulsing;
• is located mainly in the occiput;
• is combined with a fear of light, nausea and vomiting.

Every third patient has a headache as the only symptom. Vomiting during a hemorrhage occurs several times. It does not bring relief. Its appearance is due to irritation of the emetic center of the brain. Symptoms include impaired consciousness. Most often develops a sopor or a coma.

With a hemorrhage on the background of an aneurysm, a brief loss of consciousness is possible, and in the following days a stupor or sopor is observed. The development of coma indicates the involvement of the brain in the process of the ventricles. Patients are often very excitable. Symptoms include a feeling of blood rush to the head, pain in the rotation of the eyeballs, a violation of the heartbeat and breathing, the appearance of red circles in the eye area. During an attack a person can fall.

Often such people cry out and ask for help. Sometimes the debut of the disease resembles an epileptic fit. It is characterized by tilting the head, the appearance of seizures and foam from the mouth. Pupils can become wide. The sight rushes to the side of defeat.

Oculomotor disorders( strabismus, floating movements of eyeballs, nystagmus) are very pronounced. It is possible to lower the corner of the mouth and eyelid from one side. A "symptom of the sail" is often revealed. It is characterized by a weak filling of the cheeks with air. Symptoms often include increased body temperature, decreased heart rate, increased blood pressure.

5 Neurological Symptoms

With subarachnoid hemorrhage, neurological symptoms are pronounced. They include meningeal symptoms, limitation of movements of the upper and lower extremities, impaired sensitivity, difficulty in speaking. Very often, meningeal symptoms are revealed. These include stiff neck and neck muscles, vomiting, hypersensitivity( hyperesthesia), fear of light, positive symptoms of Kernig and Brudzinsky.

The most frequent meningeal symptom is the stiffness of the occiput muscles. Such people can not reach to the chest with the chin. In some patients, head tilting is observed for the same reason. If in a supine position on the back a person is not able to unbend the knee bent in the knee, then this indicates a positive Kernig symptom. Often during such a study, patients complain of pain.

Often a positive symptom of Bechterew appears. For this it is necessary to knock on the zygomatic arc. In sick people, there is pain and grimace. With subarachnoid hemorrhage, positive symptoms of Brudzinsky can be detected. There are only 4( buccal, upper, middle and lower).Meningeal symptoms are most pronounced in the first day of the disease.

6 Atypical course of the disease and complications of

Each third patient has a hemorrhage in an atypical form. It can resemble the inflammation of the brain envelopes, hypertensive crisis, radiculitis or psychosis. The following atypical forms of the course of subarachnoid hemorrhage are distinguished:

• migraine;
• is false-hypertensive;
• is false-inflammatory.

With migraine headache, the first symptom is headache. The person thus remains in consciousness. Meningeal signs appear in a few days. With a false-hypertensive form, the headache appears against the background of hypertension. In this situation, it is impossible to diagnose without an instrumental examination, since the stroke resembles a hypertensive crisis.

High temperature, pronounced meningeal symptoms and headache indicate a false-inflammatory form of stroke. In this case, you can mistakenly suspect meningitis. The consequences of hemorrhagic stroke can be very serious. A lethal outcome is observed in more than 50%.The most common effects of subarachnoid hemorrhage are as follows:

• spasm of cerebral vessels;
• development of ischemic stroke;
• intracerebral or intraventricular hemorrhage;
• hydrocephalus;
• cerebral edema;
• displacement of structures;
• dehydration of the body;
• decrease in the level of sodium in the blood;
• is a congestive form of pneumonia;
• cardiac rhythm disturbance;
• myocardial infarction;
• heart failure;
• thrombosis;
• thromboembolism;
• kidney damage( pyelonephritis);
• formation of a stressful stomach ulcer;
• persistent neurological disorders.

There are always consequences. Stroke never runs without a trace. Such consequences as the presence of persistent paresis and paralysis, violation of speech function and increase of muscle tone, lead to disability. With massive hemorrhage and prolonged narrowing of the cerebral arteries, the likelihood of death is high.

7 Examination and treatment tactic

Treatment is performed after a physical examination, CT or MRI of the brain, angiography, electrocardiography, blood pressure measurement, duplex scanning and ultrasound. Differential diagnosis is carried out with ischemic stroke, hypertonic crisis, meningitis, hydrocephalus, pheochromocytoma. Treatment is carried out in a hospital. With self-treatment, the consequences can be deplorable.

Basic medication involves the use of diuretics, hemostatics, antihypertensive drugs( with blood pressure above 220/100 mm Hg), calcium channel blockers, neuroprotectors. Symptomatic drugs are prescribed( anticonvulsant, sedative, antiemetic).With developing edema of the brain, diuretics( Lasix, Mannitol), magnesium sulfate and oxygen therapy are used. If necessary, the ventilator is used. With hemorrhagic stroke, treatment can be radical.

If conservative treatment does not help, an operation( trepanation or drainage) is performed. With an aneurysm, clipping or endovascular occlusion is performed. In severe cases, stenting or angioplasty may be necessary.

All treatment should be provided in the first 72 hours, otherwise the consequences will be bad. Prevention of hemorrhage includes proper nutrition with restriction of fats and salt, easy exercise, refusal from smoking and alcohol, normalization of weight, control of blood pressure. An aneurysm requires a timely operation.