CONTENT

Definition

Subarachnoid haemorrhage is sudden bleeding into the cavity between the brain and the
tissues that cover the brain (the subarachnoid space) in the area between the arachnoid membrane
and the pia mater surrounding the brain. Subarachnoid haemorrhage is a life-threatening disorder
that can quickly produce serious permanent disability. It occurs in various clinical contexts, the
most common being head trauma.

Anatomi

The brain is wrapped by a mesodermal sheath, meninges. Meninges are divided into three
layers, namely the dura mater, pia mater, and arachnoid mater.

Dura mater

Pia mater

Arachnoid mater

Etiology

Subarachnoid Haemorrhage happens primarily due to a ruptured berry aneurysm. This

condition is responsible for about 85 percent of SAH cases. In some cases, trauma to the brain
during an injury can cause aneurysms and result in a subarachnoid hemorrhage. Rupture of
arteriovenous malformations (AVM) is the second most identifiable cause of SAH, accounting
for 10% of cases of SAH. Several other causes make up the remaining 5% of SAH. The others
that can cause SAH are :

a) Angioma
b) Neoplasm
c) Mycotic Aneurisme
d) Moya moya desease
e) Head injury
f) Cerebral vascuilitis
Genetic factors also play a role in the occurrence of SAH but still rare. Environmental factors
associated with acquired blood vessel wall defects including age , hypertension , smoking and
artrosklerosis also can cause SAH to happen.

Patofisiology

Aneurysms are acquired lesions related to hemodynamic stress on the arterial walls at
bifurcation points and bends. Saccular or berry aneurysms are specific to the intracranial arteries
because their walls lack an external elastic lamina and contain a very thin adventitiafactors
that may predispose to the formation of aneurysms. Aneurysms usually occur in the terminal
portion of the internal carotid artery and the branching sites on the large cerebral arteries in the
anterior portion of the circle of Willis. The early precursors of aneurysms are small outpouchings
through defects in the media of the arteries.

When an aneurysm ruptures, blood extravasates under arterial pressure into the
subarachnoid space and quickly spreads through the cerebrospinal fluid around the brain and
spinal cord. Blood released under high pressure may directly cause damage to local tissues.
Blood extravasation causes a global increase in intracranial pressure (ICP). Meningeal irritation
occurs.

Sign and Symptomps

Signs and symptoms of SAH range from subtle prodromal events to the classic
presentation. The most common premonitory symptoms are as follows:

a) Headache (48%)
b) Dizziness (10%)
c) Orbital pain (7%)
d) Diplopia (4%)
e) Visual loss (4%)

Signs present before SAH include the following:

a) Sensory or motor disturbance (6%)

b) Seizures (4%)
 c) Ptosis (3%)
d) Bruits (3%)
e) Dysphasia (2%)

Risk Factor

Although risk factors for SAH have been evaluated extensively, little conclusive evidence
has been derived. Smoking appears to be a significant risk factor, as does heavy alcohol
consumption. The risk of AVM rupture is greater during pregnancy. Data regarding the
relationship between hypertension and SAH are conflicting. Previously documented acute severe
hypertension with diastolic pressure over 110 mm Hg has been linked to SAH.

Treatment