SUBARACHNOID HEMORRHAGE

Course overview

SUBARACHNOID HEMORRHAGES ARE LIFE-THREATENING AND RESULT FROM THE ACCUMULATION OF BLOOD BETWEEN THE ARACHNOID AND PIA MATER. THE INCIDENCE OF SUBARACHNOID HEMORRHAGE IN THE UNITED STATES IS BETWEEN 10 TO 14 OUT OF 100,000 INDIVIDUALS PER YEAR. ALTHOUGH PRESENTATIONS MAY VARY, THE CHARACTERISTIC PRESENTING SYMPTOM IS THE THUNDERCLAP HEADACHE, WHICH PATIENTS MAY DESCRIBE AS THE “WORST HEADACHE OF MY LIFE.” THIS SHOULD PROMPT FURTHER IMAGING. THE HEADACHE OFTEN IS ASSOCIATED WITH NAUSEA, VOMITING, AND DIPLOPIA. QUITE OFTEN SIGNS OF MENINGISMUS ARE PRESENT DUE TO THE SPREAD OF BLOOD INTO THE FOURTH VENTRICLE AND FURTHER DOWN THE SPINAL CORD, IRRITATING NERVES AND CAUSING NECK AND BACK PAIN. CRANIAL NERVE DEFICITS CAN OCCUR. PRACTITIONERS SHOULD PERFORM A DETAILED EXAM. THE PRESENCE OF FOCAL DEFICIT INCREASES THE GRADE OF SUBARACHNOID HEMORRHAGE AND CHANGES THE PERSPECTIVE OF POST-EVENT RECOVERY. PATIENTS WITH A HIGH-GRADE SUBARACHNOID HEMORRHAGE QUITE OFTEN PRESENT IN A STATE OF COMA THAT CALLS FOR A QUICK EVALUATION AND URGENT TREATMENT, AS THE COMA CAN BE REVERSIBLE. IN ADDITION TO SUBARACHNOID HEMORRHAGE PATIENTS MAY HAVE A CONCURRENT INTRAOCULAR HEMORRHAGE, KNOWN AS TERSON SYNDROME. WHEN TERSON SYNDROME IS PRESENT, AN OPHTHALMOLOGY SERVICE SHOULD BE CONSULTED TO HELP WITH THE CARE OF THE PATIENT. EIGHTY PERCENT OF PATIENTS THAT DEVELOP TERSON SYNDROME REQUIRE REGULAR FOLLOW-UP VISITS BUT DO NOT REQUIRE FURTHER INTERVENTION. THIS ACTIVITY REVIEWS THE EVALUATION AND MANAGEMENT OF SUBARACHNOID HEMORRHAGES AND HIGHLIGHTS THE ESSENTIAL ROLE OF THE INTERPROFESSIONAL TEAM IN CARING FOR THOSE WITH THIS GRAVE CONDITION.