Subarachnoid Haemorrhage

Intracerebral cortex


Subdural space

Subarachnoid space

Intracerebral cortex

Intracranial vessels lie in the subarachnoid space and give off small perforating branches to the brain tissue. Bleeding from these vessels or from an associated aneurysm occurs primarily into this space. Some intra-cranial aneurysms are imbedded within the brain tissue and their rupture causes intracerebral bleeding with or without sub-arachnoid haemorrhage.

Occasionally the arachnoid layer gives way and a subdural haematoma results. INCIDENCE

Subarachnoid haemorrhage occurs in approximately 10-15 per 100 000 per year. CAUSE

Cerebral aneurysms are the most frequent cause of subarachnoid haemorrhage, with arteriovenous malformations accounting for 6%.

In some patients detailed investigation fails to reveal a source of the haemorrhage. Hypertension may account for some. Cryptic arteriovenous malformations or small thrombosed aneurysms may contribute to the remainder.



A-V malformations Bleeding diathesis Anticoagulants Tumours Vasculitis



The severity of the symptoms is related to the severity of the bleed.

Usually the headache is severe and the onset instantaneous (often described as a 'blow to the head'). A transient or prolonged loss of consciousness or epileptic seizure may immediately follow. Nausea and vomiting commonly occur. Symptoms continue for many days.

Occasionally, the headache is mild (although still instantaneous) and may represent a 'warning leak' of blood before a major bleed.

Signs of meningism develop after 3-12 hours Neck stiffness is present on passive neck flexion.

Kernig's sign: stretching nerve roots by extending the knee causes pain.

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