Traumatic subarachnoid hemorrhage (tSAH) is a common injury, and trauma is the most common cause of subarachnoid hemorrhage (SAH).
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Nimodipine is given orally in the form of soft gelatin 30 mg capsules for subarachnoid hemorrhage. The recommended oral dose is 60 mg (two 30 mg capsules) every 4 hours for 21 consecutive days. In general, the capsules should be swallowed whole with a little liquid, preferably not less than one hour before or two hours after meals. Perdarahan subarachnoid adalah salah satu jenis stroke yang terjadi akibat adanya perdarahan pada ruang subarachnoid, yang berada di lapisan pelindung otak atau meningen, akibat pecah atau rusaknya pembuluh darah pada selaput meningen. Selaput meningen terdiri dari tiga lapis jaringan, yaitu lapisan durameter, lapisan arachnoid, dan lapisan piameter.
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Epidemiology
Traumatic subarachnoid hemorrhage occurs in ~35% (range 11-60%) of traumatic brain injuries1.
Pathology
Traumatic subarachnoid hemorrhage is more commonly seen in the cerebral sulci than in the Sylvian fissure and basal CSF cisterns1. When in the basal cisterns, it has an affinity for the quadrigeminal cistern and ambient cistern2. tSAH is also commonly seen adjacent to skull fractures and cerebral contusions3.
The exact mechanism of tSAH remains uncertain although it is clear that a number of etiologies exist and these will determine, at least to a degree, the distribution of blood. Causes of tSAH include 4:
Radiographic featuresCT
CT of the brain is almost always the first scan obtained in the setting of trauma, often as part of a CT panscan.
Although the sensitivity of CT to the presence of subarachnoid blood is strongly influenced by both the amount of blood and the time since the hemorrhage, in the setting of trauma scans are almost always obtained early, often mere minutes or hours from head injury, making even small amounts of blood readily visible.
The distribution and amount of blood varies greatly depending on the underlying mechanism (see above) and from patient to patient.
Often a small amount of blood is seen filling a few sulci, sometimes with an adjacent cerebral contusion. Small amounts of blood can also sometimes be appreciated pooling in the interpeduncular fossa, appearing as a small hyperdense triangle, or within the occipital horns of the lateral ventricles.
Occasionally, and worrying for an underlying arterial dissection or an aneurysmal hemorrhage that preceded trauma, larger amounts of blood may be seen around the circle of Wilis and within the posterior fossa.
Treatment and prognosis
Traumatic subarachnoid hemorrhage has a better prognosis than aneurysmal SAH 2.
Complications
Differential diagnosis
It can be difficult to delineate from tSAH, particularly as in many instances the cause of head trauma may have been spontaneous subarachnoid (e.g. while driving).
The distribution of blood, particularly if closely related to cerebral contusions can suggest traumatic etiology, whereas extensive blood around the circle of Willis should prompt arterial imaging to exclude an aneurysm.
Distinguishing between aneurysmal subarachnoid hemorrhage and traumatic non-aneurysmal subarachnoid hemorrhage is not always possible, and the trauma may have in reality been precipitated by a spontaneous aneurysmal hemorrhage (e.g. while driving).
That having been said, there are helpful features in suggesting that subarachnoid hemorrhage is the result of trauma, rather than the reason for trauma. These features include:
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Related Radiopaedia articlesStroke and intracranial haemorrhage
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When a cerebral aneurysm ruptures, blood will fill the space surrounding the brain.
Subarachnoid hemorrhage occurs when a blood vessel just outside the brain ruptures. The area of the skull surrounding the brain (the subarachnoid space) rapidly fills with blood. A patient with subarachnoid hemorrhage may have a sudden, intense headache, neck pain, and nausea or vomiting. Sometimes this is described as the worst headache of one’s life. The sudden buildup of pressure outside the brain may also cause rapid loss of consciousness or death.
What causes it?
Subarachnoid hemorrhage is most often caused by abnormalities of the arteries at the base of the brain, called cerebral aneurysms. These are small areas of rounded or irregular swellings in the arteries. Where the swelling is most severe, the blood vessel wall becomes weak and prone to rupture. View an interactive tutorial on cerebral aneurysms from the Toronto Brain Vascular Malformation Study Group.
Who gets it?
Surgical treatment of aneurysms involves placing clip on neck of aneurysm.
The cause of cerebral aneurysms is not known. They may develop from birth or in childhood and grow very slowly. Some people have multiple aneuryms. Subarachnoid hemorrhage can occur at any age, including in teenagers and young adults and is slightly more common in women than men.
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