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Subarachnoid Hemorrhage

Subarachnoid haemorrhage (SAH) refers to bleeding between the membranes surrounding the brain. It is a type of stroke caused by bleeding from an aneurysm in 50-80% of cases. Symptoms include a severe headache, neck stiffness, nausea, and loss of consciousness. Diagnosis involves CT scans, lumbar puncture, and cerebral angiography. Treatment focuses on preventing rebleeding, vasospasm, and complications through medications, monitoring, and managing the patient's condition.

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Shaibu Ham
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125 views17 pages

Subarachnoid Hemorrhage

Subarachnoid haemorrhage (SAH) refers to bleeding between the membranes surrounding the brain. It is a type of stroke caused by bleeding from an aneurysm in 50-80% of cases. Symptoms include a severe headache, neck stiffness, nausea, and loss of consciousness. Diagnosis involves CT scans, lumbar puncture, and cerebral angiography. Treatment focuses on preventing rebleeding, vasospasm, and complications through medications, monitoring, and managing the patient's condition.

Uploaded by

Shaibu Ham
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Nachinab Gilbert

 The term subarachnoid haemorrhage (SAH) refers


to extravasation of blood into the subarachnoid
space between the pia and arachnoid membranes

 SAH constitutes half of all spontaneous atraumatic


intracranial hemorrhages; the other half consists of
bleeding that occurs within the brain parenchyma.

 SAH is a serious, life threatening type of stroke


caused by bleeding into the space surrounding the
brain.
 Intracranial aneurysm
 Trauma, (severe) head injury
 Hypertension
 Anticoagulant therapy
 Increase age
 Smoking
 SAH occurs in 6% to 11% of 100,000 people each
year. Aneurysms rupture account for 50% to 80%
of these cases.

 Women are at higher risk than men. it occurs at


any age even children but they are most common
in people between age 45 and 70.
 when blood is released into the Subarachnoid
space, it irritates the lining of the brain by
increasing pressure on the brain and damage brain
cells shift from its position and herniated

 At the same time , the area of the brain that


previously received oxygen rich blood from the
affected artery is also now deprived of blood
resulting in stroke

 Blockage of the normal cerebrospinal fluid


circulation leads to enlargement of
ventricles,(hydrocephalus) causing confusion,
lethargy , loss of consciousness and vasospasm
which occurs between 5-10 days after SAH
 severe headache (thunder clap)
 pain and rigidity of the back of the neck (nuchal
rigidity) and spine due to meningeal irritation
 Visual disturbances (visual loss, diplopia) occur
when the aneurysm is adjacent to the occulomotor
nerve
 Tinnitus, dizziness, and hemiparesis may also
occur
 Loss of alertness
 Unconsciousness
 Confusion
 Irritability
 Nausea
 Vomiting
 Numbness
 Seizures
 Stiff neck
 Eyelid drooping
 Physical assessment: to evaluate neurological
status e.g. level of consciousness

 Computed tomography: to detect bleeding,


edema, displacement

 Lumbar puncture to detect blood in CSF which is


pink, blood tinged

 Laboratory blood analysis : to detect infection


 Cerebral angiography : detect blood vessel
aneurysms
 Transcranial Doppler ultrasound : measure blood
flow within the vessels

 Magnetic resonance imaging (MRI) and magnetic


resonance angiography (MRA) to detect bleeding
severity and vascular lesions
 The goals of medical treatment of hemorrhagic
stroke are to allow the brain to recover from the
initial insult (bleeding), to prevent or minimize the
risk for rebleeding, and to prevent or treat
complications

 Anti-hypertensives, Calcium channel blockers e.g.


nimodipine prevent arterial spasms

 Analgesic e.g. morphine to reduce pressure and


headache in skull
 Anti-anxiety drugs and anti-convulsant agent e.g.
phenytoin to prevent seizures
 Anti-emetic e.g. promethazine to prevent
vomiting
Airway maintenance
 Patient should be placed laterally or semiprone
position to facilitate drainage of secretions
 Suction if the need be
 Mechanical ventilation and oxygen should be
administered if indicated
 Assess level of consciousness
 Glasgow’s coma scale should be used to
monitor progress or deterioration
 Monitor vital signs
 Monitor and record intake and output
 Maintain hydration status through
administration of infusion
 Feed through nasogastric tubes
Urinary and bowel elimination
 Pass urinary catheter and attach to drainage
system(uro bag).
 Use faecal collection bags for faecal incontinence
patients
 Give or assist patient bedbath
 Give catheter care if insitu
 Ensure clean and aseptic procedure to
prevent infections
 Repeated bleeding
 Cerebral vasospasm
 Stroke
 Secondary cerebral ischaemia

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