Subarachnoid Hemorhage

Dr. Holly Ryan

Editor: Omar Lopez MS3

Background

1. Headache is a very common complaint in the ED, up to 2% of patients that walk into the emergency department have the CC of HA.

  • This doesn’t seem like a lot but the most common ED complaint is abdominal pain and that’s about 7%

2. SAH is a stroke

  • Although it only encompasses 3% of all strokes, it is still a devastating disease.

3. Patient Population has a broad age range

  • The average age for an ischemic stroke is greater than or equal to 65 while SAH is around 50.

4. Life-threatening and can be fatal.

  • 10% of patients with non-traumatic SAH have sudden death

  • Untreated SAH leads to one-year mortality up to 65%... thankfully this can be reduced to 18% if patients are appropriately treated and managed

  • However, there is still a 12% reported rate of missed diagnosis.

Definition

  • A bleed in the subarachnoid space which is usually filled with CSF, to protect and cushion our brain.

  • This space is the closest to the actual brain and that is important physiologically because blood that sits on the brain parenchyma can cause irritation, which is why these patients are at increased risk for seizures.




Causes


Presentation

Work- Up

ACEP Clinical Guidelines and Policies

Lumbar Puncture

CT Angiography

Literature Review

Management and Disposition

Controversies in Care: Seizure PPX

References