FACTOID # 18: Alaska spends more money per capita on elementary and secondary education than any other state.
 
 Home   Encyclopedia   Statistics   States A-Z   Flags   Maps   FAQ   About 
 
WHAT'S NEW
 

SEARCH ALL

FACTS & STATISTICS    Advanced view

Search encyclopedia, statistics and forums:

 

 

(* = Graphable)

 

 


Encyclopedia > Subarachnoid hemorrhage
Subarachnoid hemorrhage
Classification & external resources
CT scan of the brain showing subarachnoid hemorrhage as a white area in the center
ICD-10 I60., S06.6
ICD-9 430, 852.0-852.1
DiseasesDB 12602
MedlinePlus 000701
eMedicine med/2883  neuro/357 emerg/559
MeSH D013345

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i.e., the area between the arachnoid membrane and the pia mater. It may arise due to trauma or spontaneously, and is a medical emergency which can lead to death or severe disability even if recognized and treated in an early stage. Treatment is with close observation, medication and early neurosurgical investigations and treatments. Subarachnoid hemorrhage causes 5% of all strokes. 10-15% die before arriving in hospital, and average survival is 50%.[1] Image File history File links Download high-resolution version (663x841, 86 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Subarachnoid hemorrhage ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // S00-T14 - Injury (S00-S09) head (S00) Superficial injury of head (S01) Open wound of head (S02) Fracture of skull and facial bones (S03) Dislocation, sprain and strain of joints and ligaments of head (S04) Injury of cranial nerves (S05) Injury of eye and orbit (S06) Intracranial injury (S07) Crushing... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... For other uses, see Bleeding (disambiguation). ... The meninges (singular meninx) are the system of membranes that contain the brain. ... The arachnoid layer is the second or middle layer of the meninges, the membranes surrounding the brain. ... [www. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... {{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ... Insertion of an electrode during neurosurgery for Parkinsons disease. ... For other uses, see Stroke (disambiguation). ...

Contents

Signs and symptoms

The classic symptom of subarachnoid hemorrhage is thunderclap headache ("most severe ever" headache developing over seconds to minutes). 10% of all people with this symptom turn out to have a subarachnoid hemorrhage, and is the only symptom in about a third of all SAH patients. Other presenting features may be vomiting (non-specific), seizures (1 in 14) and meningism. Confusion, decreased level of consciousness or coma may be present. Intraocular hemorrhage (bleeding into the eyeball) may occur. Subhyaloid haemorrhages may be visible on fundoscopy (the hyaloid membrane envelopes the vitreous body).[1] A thunderclap headache is a sudden and severe headache, diagnosed via a process of exclusion with accompanying negative CT and lumbar puncture results. ... Emesis redirects here. ... This article is about epileptic seizures. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ... Look up Confusion in Wiktionary, the free dictionary Confusion can have the following meanings: Unclarity or puzzlement, e. ... For other uses, see Coma (disambiguation). ... Vitreous humour is the clear aqueous solution that fills the space between the lens and the retina of the vertebrate eyeball. ...


In a patient with thunderclap headache, none of the signs mentioned are helpful in confirming or ruling out hemorrhage, although a seizure makes bleeding from an aneurysm more likely. Oculomotor nerve abnormalities (affected eye looking downward and outward, pupil widened and less responsive to light) may indicate a bleed at the posterior inferior cerebellar artery.[1] Post surgical photo of brain aneurysm survivor. ... The oculomotor nerve () is the third of twelve paired cranial nerves. ... The human eye The pupil is the central transparent area (showing as black). ... The posterior inferior cerebellar artery (PICA) is one of the three main arterial blood supplies for the cerebellum. ...


As a result of the bleeding, blood pressure often rises rapidly, together with a release of adrenaline and similar hormones. As a result, substantial strain is put on the heart, and neurogenic pulmonary edema, cardiac arrhythmias, electrocardiographic changes (some resembling a heart attack) and cardiac arrest (3%) may occur rapidly after the onset of hemorrhage.[2][1] A sphygmomanometer, a device used for measuring arterial pressure. ... Epinephrine (INN) or adrenaline (BAN) is a hormone and a neurotransmitter. ... The heart and lungs, from an older edition of Grays Anatomy. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... “QRS” redirects here. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...


Bleeding into the subarachnoid space may occur as a result of injury or trauma. SAH in a trauma patient is often detected when a patient who has been involved in an accident becomes less responsive or develops hemiparesis (one-sided weakness) or changed pupillary reflexes, and Glasgow Coma Score calculations deteriorate. Headache is not necessarily present.[citation needed] Hemiparesis is the partial paralysis of one side of the body. ... The Glasgow Coma Scale (also known as Glasgow Coma Score or simply GCS) was devised by doctors to assess head trauma and, importantly, to help keep track of patients progress over a period of time. ...


Diagnosis

The initial steps in a case of possible subarachnoid hemorrhage are obtaining a medical history and performing a physical examination; these are aimed at assessing the likelihood of the condition, and identifying other potential causes of the symptoms. Neck stiffness and other signs of meningism may be present, as well as a reduced level of consciousness. The medical history of a patient (sometimes called anamnesis [1][2] ) is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis). ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ...


The diagnosis of subarachnoid hemorrhage cannot be made on clinical grounds alone. Medical imaging is usually required to confirm or exclude bleeding. The modality of choice is computed tomography (CT/CAT) of the brain. This has a high sensitivity (it will correctly identify >95% of the cases), especially on the first day after the onset of bleeding. Some data suggests that magnetic resonance imaging (MRI) may be more sensitive after several days. In those where the CT/MRI scan is normal, lumbar puncture (removal of cerebrospinal fluid/CSF with a needle from the lumbar sac under local anesthetic) will identify another 3% of the cases by demonstrating xanthochromia (yellow appearance of centrifugated fluid) or bilirubin (a breakdown product of hemoglobin) in the CSF.[1] Medical imaging designates the ensemble of techniques and processes used to create images of the human body (or parts thereof) for clinical purposes (medical procedures seeking to reveal, diagnose or examine disease) or medical science (including the study of normal anatomy and function). ... negron305 Cat scan redirects here. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... “MRI” redirects here. ... A patient undergoes a lumbar puncture at the hands of a neurologist. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... A local anesthetic is a drug that reversibly inhibits the propagation of signals along nerves. ... Bilirubin is a yellow breakdown product of normal heme catabolism. ... Structure of hemoglobin. ...


Once a subarachnoid hemorrhage is confirmed, the next question is about its origin. CT angiography (using radiocontrast) to identify aneurysms is generally the first step, as invasive angiography (injecting radiocontrast through a catheter advanced to the brain arteries) has a small rate of complications but is useful if there are plans to obliterate the source of bleeding, such as an aneurysm, at the same time.[1] Radiocontrast agents (or simply contrast agents) are compounds used to improve the visibility of internal bodily structures in an X-ray image. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ...


Causes

Spontaneous SAH is most often due to rupture of cerebral aneurysms (85%), weaknesses in the wall of the arteries of the brain that enlarge. While most cases of SAH are due to bleeding from small aneurysms, there is evidence from research that larger aneurysms (which are rarer) are still more likely to rupture. A further 10% of cases is due to non-aneurysmal perimesencephalic hemorrhage, in which the blood is limited to the area of the midbrain. No aneurysms are generally found. The remaining 5% are due to vasculitic damage to arteries, other disorders affecting the vessels, disorders of the spinal cord blood vessels, and bleeding into various tumors.[1] SAH is six times more common in young smokers (smokers under 21) than in nonsmokers (Royal College of Physicians. Smoking and the young. Tob Control 1992; 1:231-5.). A cerebral aneurysm or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. ... Section of an artery For other uses, see Artery (disambiguation). ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ... For malignant tumors specifically, see cancer. ...


Classification

There are several grading scales available for subarachnoid hemorrhage. These have been derived by retrospectively matching characteristics of patients with their outcomes. In addition to the ubiquitously used Glasgow Coma Scale, three other specialized scores are in use.[3] The Glasgow Coma Scale is a neurological scale which seems to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. ...

Hunt and Hess scale

The first scale of severity, described by Hunt and Hess in 1968:[4]

  • Grade 1: Asymptomatic; or minimal headache and slight nuchal rigidity. Approximate survival rate 70%.
  • Grade 2: Moderate to severe headache; nuchal rigidity; no neurologic deficit except cranial nerve palsy. 60%.
  • Grade 3: Drowsy; minimal neurologic deficit. 50%.
  • Grade 4: Stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity and vegetative disturbances. 20%.
  • Grade 5: Deep coma; decerebrate rigidity; moribund. 10%.
Fisher grade

The Fisher Grade classifies the appearance of subarachnoid hemorrhage on CT scan:[5] A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ... Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... Palsy is a medical term derived from the word paralysis that is defined as paralysis of a body part often accompanied by loss of feeling and uncontrolled body movements such as shaking. ... Hemiparesis is the partial paralysis of one side of the body. ... A woman with malaria displaying decerebrate posturing, with arms extended at her sides. ... For other uses, see Coma (disambiguation). ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around...

  • Grade 1= No hemorrhage evident
  • Grade 2= Subarachnoid hemorrhage less than 1 mm thick
  • Grade 3= Subarachnoid hemorrhage more than 1 mm thick
  • Grade 4= Subarachnoid hemorrhage of any thickness with intra-ventricular hemorrhage (IVH) or parenchymal extension
World Federation of Neurosurgeons

The World Federation of Neurosurgeons classification:[6]

  • Class 1 - GCS (Glasgow Coma Scale)15
  • Class 2 - GCS 13-14 without focal neurological deficit
  • Class 3 - GCS 13-14 with focal neurological deficit
  • Class 4 - GCS 7-12 with or without focal neurological deficit
  • Class 5 - GCS <7 with or without focal neurological deficit

Treatment

General measures

The first priority is stabilization of the patient. In those with a depressed level of consciousness, intubation and mechanical ventilation may be required. Blood pressure, pulse, respiratory rate and Glasgow Coma Scale are monitored frequently. Once the diagnosis is confirmed, admission to an intensive care unit (ICU) may be considered preferable, especially given that 15% have a further episode (rebleeding) in the first hours after admission. Nutrition is an early priority, with oral or nasogastric tube feeding being preferable over parenteral routes. Analgesia (pain control) is generally restricted to non-sedating agents, as sedation would interfere with the monitoring of the level of consciousness. There is emphasis on the prevention of complications; for instance, deep vein thrombosis is prevented with compression stockings and/or intermittent pneumatic compression.[1] This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling. ... mechanical or forced ventilation is the use of powered equipment, e. ... ICU room An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised department in a hospital that provides intensive care medicine. ... Nasogastric intubation is a medical process involving the insertion of a plastic tube (nasogastric tube, NG tube) through the nose, past the throat, and down into the stomach. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ... This article is about Deep-vein thrombosis. ... Compression stockings are specialised stockings that are worn to prevent poor blood circulation in the legs. ...


Prevention of rebleeding

Those patients with a large hematoma, depressed level of consciousness or focal neurology may be candidates for urgent surgical removal of the blood or occlusion of the bleeding site. The remainder are admitted and stabilized more extensively, and undergo an transfemoral angiogram or CT angiogram at a later stage. In those where the bleeding is from an aneurysm (as opposed to non-aneurysmal perimesencephalic hemorrhage), most neurosurgical centers use either coiling or clipping of the aneurysm to prevent rebleeding. After the first 24 hours, rebleeding risk is about 40% over four weeks, suggesting that interventions should be aimed at reducing this risk.[1] Cerebral angiography or arteriography is a form of medical imaging that visualises the arterial and venous supply of the brain. ...


Currently there are two treatment options for brain aneurysms: surgical clipping or endovascular coiling. Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937. It consists of performing a craniotomy, exposing the aneurysm, and closing the base of the aneurysm with a clip.[7] The surgical technique has been modified and improved over the years. Surgical clipping remains the best method to permanently eliminate aneurysms. Endovascular coiling was introduced by Guido Guglielmi at UCLA in 1991.[8] It consists of passing a catheter into the femoral artery in the groin, through the aorta, into the brain arteries, and finally into the aneurysm itself. Once the catheter is in the aneurysm, platinum coils are pushed into the aneurysm and released. These coils initiate a clotting or thrombotic reaction within the aneurysm that, if successful, will eliminate the aneurysm. In the case of broad-based aneurysms, a stent is passed first into the parent artery to serve as a scaffold for the coils ("stent-assisted coiling"). Walter Dandy, American neurosurgeon is credit for the development of air encefalography in 1918, a major breaktrough in brain imaging and set the basis for the development of neuroradiology ... The Johns Hopkins Hospital is a teaching hospital in Baltimore, Maryland. ...


At this point it appears that the risks associated with surgical clipping and endovascular coiling, in terms of stroke or death from the procedure, are the same. The major problem associated with endovascular coiling, however, is the high recurrence rate and subsequent bleeding of the aneurysms. For instance, a major French study reported in 2007 indicates that 28.6% of aneurysms recurred within one year of coiling, and that the recurrence rate increased with time.[9] These results are similar to those previously reported by other endovascular groups; a series from Canada reported in 2003 found that 33.6% of aneurysms recurred within one year of coiling.[10] The long-term coiling results of one of the two prospective randomized studies comparing surgical clipping versus endovascular coiling (the International Subarachnoid Aneurysm Trial or ISAT), too, suggest that the need for late retreatment of aneurysms is 6.9 times more likely for endovascular coiling as compared to surgical clipping.[11]


Therefore it appears that although endovascular coiling is associated with a shorter recovery period as compared to surgical clipping, it is also associated with a significantly higher recurrence and bleeding rate after treatment. Patients who undergo endovascular coiling need to have annual studies (such as MRI/MRA, CTA, or angiography) indefinitely to detect early recurrences.[citation needed] If a recurrence is identified, the aneurysm needs to be retreated with either surgery or further coiling. The risks associated with surgical clipping of previously-coiled aneurysms are very high.[citation needed] Ultimately, the decision to treat with surgical clipping versus endovascular coiling should be made by a cerebrovascular team with extensive experience in both modalities. At present it appears that only older patients with aneurysms that are difficult to reach surgically are more likely to benefit from endovascular coiling. These generalizations, however, are difficult to apply to every case, which is reflected in the wide variabilty internationally in the use of surgical clipping versus endovascular coiling.[citation needed]


Medical treatment is available to both reduce the risk of repeat bleeding, and to treat a serious complication of SAH called vasospasm. In the case of spontaneous SAH from an aneurysm, there is a significant risk of repeat bleeding until definitive surgical intervention can be performed. During this waiting period medical treatments to control blood pressure, bed rest, and a quiet environment reduce the risk of rebleed.


Prevention of vasospasm

Vasospasm is a serious complication of SAH. It may be seen in 50% of SAH patients studied with angiography, and is symptomatic roughly 30% of the time. This condition can be verified by transcranial doppler or cerebral angiography, and can cause ischemic brain injury which can cause permanent brain damage, and if severe can be fatal. Nimodipine is an oral calcium channel blocker, that has been shown to reduce the chance of a bad outcome, even if it does not significantly reduce the amount of angiographic vasospasm.[12][13] Vasospasm refers to a condition in which blood vessels spasm, leading to constriction. ... Transcranial Doppler (TCD) is a test that measures the velocity of blood flow through the brains blood vessels. ... Cerebral angiography or arteriography is a form of medical imaging that visualises the arterial and venous supply of the brain. ... Nimodipine (marketed by Bayer as Nimotop®) is a dihydropyridine calcium channel blocker originally developed for the treatment of high blood pressure. ...


Follow-up

A patient who recovers without immediate intervention may receive follow-up angiography to identify aneurysms which may be amenable to either surgical clipping or endovascular coiling to prevent recurrent episodes of SAH. Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Post surgical photo of brain aneurysm survivor. ...


Complications

Complications of SAH can be acute, subacute, or chronic.

For other uses, see Coma (disambiguation). ... Herniation, a deadly side effect of very high intracranial pressure, occurs when the brain shifts across structures within the skull. ... Intracranial pressure, (ICP), is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brains circulating blood volume. ... Pulmonary edema is swelling and/or fluid accumulation in the lungs. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... Myocardium is the muscular tissue of the heart. ... Vasospasm refers to a condition in which blood vessels spasm, leading to constriction. ... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... Calcium channel blockers are a class of drugs with effects on the muscle of the heart and the muscles of the rest of the body. ... Nimodipine (marketed by Bayer as Nimotop®) is a dihydropyridine calcium channel blocker originally developed for the treatment of high blood pressure. ... The electrolyte disturbance hyponatremia or hyponatraemia exists in humans when the sodium level in the plasma falls below 135 mmol/l. ... For sodium in the diet, see Edible salt. ... The syndrome of inappropriate antidiuretic hormone (SIADH) is a condition commonly found in the hospital population, especially in patients being hospitalized for central nervous system (CNS) injury. ... Cerebral salt-wasting syndrome (CSWS) is a disease featuring hyponatremia (low blood sodium levels) and dehydration in response to disease processes in or surrounding the brain. ... This article is about human pneumonia. ...

Prognosis

After the SAH is treated the patients can experience prolonged, even permanently reoccurring headaches.


Nearly half the cases of SAH are either dead or moribund before they reach a hospital. Of the remainder, a further 10-20% die in the early weeks in hospital from rebleeding. Delay in diagnosis of minor SAH without coma (or mistaking the sudden headache for migraine) contributes to this mortality.


Patients who remain comatose or with persistent severe deficits have a poor prognosis.


External links

References

  1. ^ a b c d e f g h i Van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet 2007;369:306-18. PMID 17258671.
  2. ^ Banki NM, Kopelnik A, Dae MW, et al (2005). "Acute neurocardiogenic injury after subarachnoid hemorrhage". Circulation 112 (21): 3314-9. doi:10.1161/CIRCULATIONAHA.105.558239. PMID 16286583. 
  3. ^ Rosen D, Macdonald R (2005). "Subarachnoid hemorrhage grading scales: a systematic review". Neurocrit Care 2 (2): 110-8. PMID 16159052. 
  4. ^ Hunt W, Hess R (1968). "Surgical risk as related to time of intervention in the repair of intracranial aneurysms". J Neurosurg 28 (1): 14-20. PMID 5635959. 
  5. ^ Fisher C, Kistler J, Davis J (1980). "Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning". Neurosurgery 6 (1): 1-9. PMID 7354892. 
  6. ^ Teasdale G, Drake C, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers J (1988). "A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies". J Neurol Neurosurg Psychiatry 51 (11): 1457. PMID 3236024. 
  7. ^ Dandy WE (1938). "Intracranial aneurysm of internal carotid artery cured by operation". Ann Surg 107: 654. 
  8. ^ Guglielmi G, Viñuela F, Dion J, Duckwiler G (1991). "Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience". J. Neurosurg. 75 (1): 8-14. PMID 2045924. 
  9. ^ Piotin M, Spelle L, Mounayer C, et al (2007). "Intracranial aneurysms: treatment with bare platinum coils--aneurysm packing, complex coils, and angiographic recurrence". Radiology 243 (2): 500-8. doi:10.1148/radiol.2431060006. PMID 17293572. 
  10. ^ Raymond J, Guilbert F, Weill A, et al (2003). "Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils". Stroke 34 (6): 1398-403. doi:10.1161/01.STR.0000073841.88563.E9. PMID 12775880. 
  11. ^ Campi A, Ramzi N, Molyneux AJ, et al (2007). "Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT)". Stroke 38 (5): 1538-44. doi:10.1161/STROKEAHA.106.466987. PMID 17395870. 
  12. ^ Allen GS, Ahn HS, Preziosi TJ, et al (1983). "Cerebral arterial spasm--a controlled trial of nimodipine in patients with subarachnoid hemorrhage". N. Engl. J. Med. 308 (11): 619-24. PMID 6338383. 
  13. ^ Dorhout Mees S, Rinkel G, Feigin V, et al (2007). "Calcium antagonists for aneurysmal subarachnoid haemorrhage". Cochrane database of systematic reviews (Online) (3): CD000277. doi:10.1002/14651858.CD000277.pub3. PMID 17636626. 

The Lancet is one of the oldest and most respected peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... For transport in plants, see Vascular tissue. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... For other forms of hypertension, see Hypertension (disambiguation). ... In kidney, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, producing the thickening of their walls and the narrowing of the lumens - hyaline arteriolosclerosis. ... While most forms of hypertension have no known underlying cause (and are thus known as essential hypertension or primary hypertension), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension). ... Renovascular hypertension (or renal hypertension) is a form of secondary hypertension. ... Ischaemic (or ischemic) heart disease is a disease characterized by reduced blood supply to the heart. ... Prinzmetals angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Dresslers syndrome is a form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). ... Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-depleted blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. ... Cor pulmonale, also known as right heart failure, is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. ... Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. ... In the heart, the endocardium is the innermost layer of tissue that lines the chambers of the heart. ... Grays Fig. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a dual flap (bi = 2) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV). ... Mitral regurgitation (MR), also known as mitral insufficiency, is the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart. ... Mitral valve prolapse (MVP) is a heart valve condition marked by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. ... Mitral stenosis is a narrowing of the orifice of the mitral valve of the heart. ... The aortic valve is one of the valves of the heart. ... Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. ... Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ... The pulmonary valve, also known as pulmonic valve, is the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. ... Pulmonary valve stenosis is a medical condition in which outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve. ... Pulmonary valve insufficiency (or incompetence, or regurgitation) is a condition where the pulmonary valve is not strong enough to prevent backflow into the right ventricle. ... The tricuspid valve is on the right side of the heart, between the right atrium and the right ventricle. ... Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. ... Tricuspid insufficiency, also termed Tricuspid regurgitation, refers to the failure of the hearts tricuspid valve to close properly during systole. ... Myocardium is the muscular tissue of the heart. ... In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. ... Dilated cardiomyopathy or DCM (also known as congestive cardiomyopathy), is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is dilated, often without any obvious cause. ... Hypertrophic cardiomyopathy, or HCM, is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause. ... This article is considered orphaned, since there are very few or no other articles that link to this one. ... Restrictive cardiomyopathy (RCM) is the least common cardiomyopathy. ... Arrhythmogenic right ventricular dysplasia (ARVD, also known as arrhythmogenic right ventricular cardiomyopathy or ARVC) is a type of nonischemic cardiomyopathy that involves primarily the right ventricle. ... The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the myocardium (Cardiac muscle). ... A heart block is a disease in the electrical system of the heart. ... A heart block denotes a disease in the electrical system of the heart. ... First degree AV block or PR prolongation is a disease of the electrical conduction system of the heart in which the PR interval is lengthened. ... Second degree AV block is a disease of the electrical conduction system of the heart. ... Third degree AV block, also known as complete heart block, is a defect of the electrical system of the heart, in which the impulse generated in the atria (typically the SA node on top of the right atrium) does not propagate to the ventricles. ... Bundle branch block refers to a disorder of the hearts electrical conducting system. ... ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6. ... Right bundle branch block (RBBB) is a cardiac conduction abnormality seen on electrocardiogram (EKG). ... Bifascicular block is a conduction abnormality in the heart where two of the three main fascicles of the His/Purkinje system are blocked. ... Trifascicular heart block is the triad of first degree heart block, right bundle branch block, and either left anterior or left posterior hemi block seen on an electrocardiogram (EKG). ... Pre-excitation syndrome is a condition where the the ventricles of the heart become depolarized too early, which leads to their premature contraction, causing arrhythmia. ... Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the Bundle of Kent. ... Lown-Ganong-Levine syndrome (LGL) is a syndrome of pre-excitation of the ventricles due to an accessory pathway providing an abnormal electrical communication from the atria to the ventricles. ... The long QT syndrome (LQTS) is a heart disease in which there is an abnormally long delay between the electrical excitation (or depolarization) and relaxation (repolarization) of the ventricles of the heart. ... The term Stokes-Adams Attack refers to a sudden, transient episode of syncope, occasionally featuring seizures. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... A supraventricular tachycardia (SVT) is a rapid rhythm of the heart in which the origin of the electrical signal is either the atria or the AV node. ... AV nodal reentrant tachycardia (AVNRT) is a type of reentrant tachycardia (fast rhythm) of the heart. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... Atrial flutter is an abnormal fast heart rhythm that occurs in the atria of the heart. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... pac This page meets Wikipedias criteria for speedy deletion. ... This article does not cite any references or sources. ... Sick sinus syndrome, also called Bradycardia-tachycardia syndrome is a group of abnormal heartbeats (arrhythmias) presumably caused by a malfunction of the sinus node, the hearts natural pacemaker. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Cardiomegaly is a medical condition wherein the heart is enlarged. ... Although ventricular hypertrophy may occur in either the left or right or both ventricles of the heart , left ventricular hypertrophy (LVH) is more commonly encountered. ... Left ventricular hypertrophy (LVH) is the thickening of the myocardium (muscle) of the left ventricle of the heart. ... Right ventricular hypertrophy (RVH) is a form of ventricular hypertrophy affecting the right ventricle. ... Cerebrovascular disease is damage to the blood vessels in the brain, resulting in a stroke. ... This article needs cleanup. ... A cerebral hemorrhage is a bleed into the substance of the cerebrum. ... Extra-axial hematoma, or extra-axial hemorrhage is a subtype of intracranial hemorrhage, or bleeding within the intracranial space, that occurs within the skull but outside of the brain tissue itself. ... Nontraumatic epidural hematoma in a young woman. ... A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Intraventricular hemorrhage (or IVH) is a bleeding of the ventricles, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral two-thirds of the spinal cord and Medulla. ... Binswangers disease is a rare form of multi-infarct dementia caused by damage to deep white brain matter. ... Moyamoya disease is an extremely rare disorder in most parts of the world except in Japan. ... Section of an artery An artery or arterial is also a class of highway. ... An arteriole is a blood vessel that extends and branchs out from an artery and leads to capillaries. ... The word capillary is used to describe any very narrow tube or channel through which a fluid can pass. ... Renal artery stenosis is the narrowing of the renal artery. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ... A plate from Grays Anatomy with yellow lines depicting the most common infrarenal location of the AAA. Abdominal aortic aneurysm, also written as AAA and often pronounced triple-A, is a localized dilatation of the abdominal aorta, that exceeds the normal diameter by more than 50%. The normal diameter... Post surgical photo of brain aneurysm survivor. ... Raynauds phenomenon (RAY-noz), in medicine, is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities, named for French physician Maurice Raynaud (1834 - 1881). ... Raynauds disease (RAY-noz) is a condition that affects blood flow to the extremities which include the fingers, toes, nose and ears when exposed to temperature changes or stress. ... Buergers disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. ... Arteritis is inflammation of the walls of arteries, usually as a result of infection or auto-immune response. ... Aortitis is the inflammation of the aorta. ... Intermittent claudication is a cramping sensation in the legs that is present during exercise or walking and occurs as a result of decreased oxygen supply. ... An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. ... In medicine, hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a genetic disorder that leads to vascular malformations. ... A spider angioma (also known as a nevus araneus, spider nevus, or vascular spider) is a type of angioma found slightly below the skins surface, often containing a central red spot and reddish extensions which radiate outwards like a spiders web. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Lymph originates as blood plasma lost from the circulatory system, which leaks out into the surrounding tissues. ... Lymph nodes are components of the lymphatic system. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... Phlebitis is an inflammation of a vein, usually in the legs. ... It has been suggested that this article or section be merged into deep vein thrombosis. ... This article is about Deep-vein thrombosis. ... May-Thurner syndrome is deep vein thrombosis of the iliofemoral vein due to compression of the left common iliac vein by overlying right common iliac artery. ... A venous thrombosis is a blood clot that forms within a vein. ... In medicine (gastroenterology and hepatology), Budd-Chiari syndrome is the clinical picture caused by occlusion of the hepatic vein. ... Renal vein thrombosis (RVT) is the formation of a clot or thrombus obstructing the renal vein, leading to a reduction in drainage of the kidney. ... Paget-Schroetter disease (also Paget-von Schrötter disease) refers to deep vein thrombosis of an upper extremity vein, including the axillary vein or subclavian vein. ... Vein gymnastics in the barefoot park Dornstetten, Germany. ... A portacaval anastomosis is a specific type of anastomosis that occurs between the veins of portal circulation and those of systemic circulation. ... This article or section is in need of attention from an expert on the subject. ... In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... Cross section showing the pampiniform plexus Varicocele is an abnormal enlargement of the veins in the scrotum draining the testicles. ... Gastric varices are dilated submucosal veins in the stomach. ... Caput medusae means dilated veins around the umbilicus. ... Superior vena cava syndrome (SVCS) is a result of obstruction of the superior vena cava. ... Lymphadenopathy is a term meaning disease of the lymph nodes. ... Azskeptic 17:34, 10 July 2007 (UTC) Lymphedema, also spelled lymphoedema, also known as lymphatic obstruction, is a condition of localized fluid retention caused by a compromised lymphatic system. ... Lymphadenopathy is swelling of one or more lymph nodes. ... “Human Head” redirects here. ... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... A human neck. ... A 21-month old with a black eye after falling 2 meters (6. ... Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. ... “Cerebral Concussion” redirects here. ... Brain contusion, a form of traumatic brain injury, is a bruise of the brain tissue. ... Nontraumatic epidural hematoma in a young woman. ... A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). ... Brachial plexus lesions are classified as traumatic or obstetric. ... Diagram of a tsetse fly, showing the head, thorax and abdomen The thorax is a division of an animals body that lies between the head and the abdomen. ... Chest trauma (or thoracic trauma) is a serious injury of the chest. ... The aorta, shown in red Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as the result of trauma. ... “Collapsed lung” redirects here. ... A hemothorax is a condition that results from blood accumulating in the pleural cavity. ... Hemopneumothorax is a medical term relating to the combination of 2 conditions, Pneumothorax (air in the chest cavity) and Hemothorax (or Hæmothorax - Blood in the chest cavity). ... The human abdomen (from the Latin word meaning belly) is the part of the body between the pelvis and the thorax. ... In anatomy, the back usually refers to the posterior side of the torso in humans and primates. ... A typical lumbar vertebra The lumbar vertebrae are the largest segments of the movable part of the vertebral column, and can be distinguished by the absence of a foramen (hole) in the transverse process, and by the absence of facets on the sides of the body. ... The pelvis (pl. ... This article is in need of attention. ... This article is about the body part. ... There is also an arms disambiguation page. ... Rotator cuff tears are problems of the rotator cuff muscles of the shoulder. ... A bruise, also called a contusion or ecchymosis, is a kind of injury to biological tissue in which the capillaries are damaged, allowing blood to seep into the surrounding tissue. ... Spinal cord injury, or myelopathy, is a disturbance of the spinal cord that results in loss of sensation and/or mobility. ...


  Results from FactBites:
 
Cerebral hemorrhage - Wikipedia, the free encyclopedia (1094 words)
Subarachnoid hemorrhage, which accounts for 5 to 10 percent of strokes (Weibers 2001) is one of the deadliest type of strokes.
Selected patients with subarachnoid hemorrhage due to a ruptured aneurysm require emergency surgery to "clip" the aneurysm off from the normal brain blood circulation, and they receive nimodipine, a drug shown to reduce incidence of vasospasm, a complication of this type of stroke.
Hemorrhagic transformation is the phenomenon in which blood vessels weakened by ischemic stroke rupture to cause hemorrhage in addition (Stroke Center, 2005; Jauch, 2003).
Subarachnoid hemorrhage - Wikipedia, the free encyclopedia (807 words)
A subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i.e., the area between the arachnoid and the pia mater.
Lumbar puncture may be needed for diagnosis in small subarachnoid bleeds that may not be detected on CT scans; the presence of xanthochromia -- a yellow tinge to the cerebrospinal fluid consequent to breakdown of blood -- is indicative of SAH, whereas gross blood may merely indicate a traumatic lumbar puncture.
This may be by craniotomy and external clipping of the bleeding vessel or aneurysm, or by interventional radiology (neuroradiology), which employs transfemoral angiography and inserting of metal coils to stem the bleeding (which is especially useful in aneurysmatic hemorrhage).
  More results at FactBites »

 
 

COMMENTARY     


Share your thoughts, questions and commentary here
Your name
Your comments

Want to know more?
Search encyclopedia, statistics and forums:

 


Press Releases |  Feeds | Contact
The Wikipedia article included on this page is licensed under the GFDL.
Images may be subject to relevant owners' copyright.
All other elements are (c) copyright NationMaster.com 2003-5. All Rights Reserved.
Usage implies agreement with terms, 1022, m