Lehigh County Health & Medicine Fall/Winter 2020 - 8

FEATURE

Acute subarachnoid hemorrhage carries a
host of immediate complications, including
injury to the brain itself. The first concern
is rebleeding of the aneurysm, which comes
with a high mortality. It is important to
find the aneurysm and treat it immediately
to prevent re-rupture. Additionally, normal
Subarachnoid hemorrhage
drainage
of cerebrospinal fluid is impaired by
When an aneurysm ruptures, the typical
the
presence
of subarachnoid blood, and acute
presentation is the " worst headache of your
nonobstructive
hydrocephalus may occur. This
life. " There is a range of clinical symptoms,
life-threatening
condition is only alleviated
from isolated severe headache, to cranial
by
placement
of
an
external ventricular drain
nerve abnormalities (usually difficulty with
to
monitor
pressure
and remove excess fluid.
eye movements), to a comatose state with
The
hemorrhage
itself
affects the surface of
posturing movements. Aneurysm rupture is
the
brain,
and
seizures
may occur during
often a sudden event but may be preceded by
the
acute
period.
Fevers
are also common,
days or hours with a " sentinel bleed " typically
causing headache. Modern CT scanners are both due to concomitant infection as well
able to detect acute subarachnoid hemorrhage as irritation of the hypothalamus, which is
95-99% of the time in the first several days, involved in temperature regulation for the
but after one week the rate of detection is body. Most concerning is the potential for
lower and may require a lumbar puncture cerebral vasospasm, or narrowing of blood
for diagnosis. A CT angiography can often vessels of the brain due to the subarachnoid
identify the aneurysm that ruptured, but a hemorrhage. Vasospasm occurs in about
formal catheter angiogram is the most sensitive 30% of subarachnoid hemorrhages and is a
major cause of permanent brain damage and
test for finding aneurysms.
disability. Careful monitoring and immediate

techniques. It is a disease that mostly affects
younger individuals, with an average age of
53 but carries a high rate of morbidity with
many survivors reporting permanent disability
in strength or cognition.

8 Lehigh County Health & Medicine | FALL / WINTER 2020

treatment of vasospasm can help improve the
overall outcome for the patient.
When an aneurysm ruptures, there may
be a host of systemic complications beyond
injury to the brain. This can include a reversible nonischemic cardiomyopathy, called
Takotsubo's cardiomyopathy. The hallmark
is apical ballooning of the heart with a
decrease in function that usually reverses in
several weeks. There may be EKG changes
due to the hemorrhage itself. There can also
be neurogenic pulmonary edema, or fluid in
the lungs that makes it difficult to oxygenate
and ventilate. Hyponatremia due to cerebral
salt wasting is a common complication and
is due to the kidneys dumping salt and increasing urine output. There may be insulin
resistance leading to hyperglycemia requiring
insulin administration. Management of these
critically ill patients with complex multisystem
involvement requires specialized training and
often the input of multiple subspecialists.
Lehigh County Health & Medicine Fall/Winter 2020

Table of Contents for the Digital Edition of Lehigh County Health & Medicine Fall/Winter 2020
