Subarachnoid hemorrhage is bleeding into the space ( subarachnoid space ) between the inner layer ( pia mater ) and middle layer ( arachnoid mater ) network melindungan the brain ( meninges ) .
* The most common cause is rupture of the vessels bulge ( aneurysm ) .
* Typically , the vessels rupture causing a sudden , severe headache , often followed by a brief loss of consciousness .
* Computed tomography , sometimes behind the spinal tap , and angiography is performed to confirm the diagnosis .
Medications used to relieve headaches and to control blood pressure , and surgery is performed to stop the bleeding .
Subarachnoid hemorrhage is a life-threatening disorder that can quickly result in serious permanent disability . This is the only type of stroke is more common among women .
CAUSE
Subarachnoid hemorrhage usually resulting from a head injury . However , head injuries resulting in bleeding that causes different symptoms and not dipertimbangankan as stroke .
Subarachnoid hemorrhage is considered as a stroke just when it happens spontaneously - that is , when the bleeding does not result from external forces , such as an accident or fall . Spontaneous bleeding usually results from sudden rupture of an aneurysm in the cerebral arteries . Aneurysms stand on weak areas in the artery wall . Aneurysms usually occur where arteries branch . Aneurysms possibility is present at birth ( congenital ) , or they developed later , after the annual high blood pressure weakens the artery walls . Most of subarachnoid hemorrhage due to aneurysm since birth .
Rather common , subarachnoid hemorrhage resulting from rupture of the abnormal tissue between the arterial vessels ( arteriovenous malformation ) in or surrounding the brain . Possibility arteriovenous malformation present at birth , but it is usually identified only when symptoms occur . Rarely , blood clots formed in the infected heart valve , traveling ( becoming an embolus ) into the arteries supplying the brain , and causes the arteries to become inflamed . The artery can then weaken and rupture .
You need to know
Nearly half of people who suffer a subarachnoid hemorrhage die before they reach the hospital .
SYMPTOMS
Before ruptured aneurysm usually does not cause symptoms until the press on nerves or blood leaking in small amounts , usually before a large outbreak ( which causes headaches ) . Then generate an alarm , such as the following below :
* Pain Kapala , which can suddenly and unusually severe ( sometimes called thunderclap headaches ) .
* Pain face or eyes .
* Double vision .
* Loss of vision around him .
Alarm can occur weekly until minutes before it broke . People should report any unusual headache doctor immediately .
Rupture can occur as sudden , severe headache that culminated in a matter of seconds . This is often followed by a brief loss of consciousness . Nearly half of those affected die before reaching the hospital . Some people remain in a coma or unconscious .
The others came out , felt dizzy and sleepy . They may feel anxious . In a matter of hours or even minutes , people can again become drowsy and confused . They do not react and can be difficult to get up . D
Natural 24 hours , blood and cerebrospinal fluid surrounding the brain injured tissue layer that protects the brain ( meninges ) , causing a stiff neck as continuous headache , frequent vomiting , dizziness , and pain in the lower back . Frequency up and down the heart rate and breathing often occurs , sometimes accompanied by seizures .
Approximately 25 % of people experience symptoms that indicate damage to specific parts of the brain , such as the following below :
* Fatigue or paralysis on one side of the body ( most often the case ) .
* Loss of taste on one part of the body .
* Difficulty understanding and use of language ( aphasia ) . Convulsions can occur and be permanent in a matter of minutes or hours . Fever is common during the first 5 to 10 days . subarachnoid hemorrhage can cause some serious problems :
* Hydrocephalus : within 24 hours . Blood from a subarachnoid hemorrhage can clot . The blood clot can prevent the fluid around the brain ( cerebrospinal fluid ) of drought as normal . As a result , accumulation of blood in the brain , increased pressure in the skull . Hydrocephalus can cause symptoms such as headache , drowsiness , dizziness , nausea , and vomiting and can increase the risk of coma and death .
* Vasospasm : about 3 to 10 days after bleeding , arteries in the brain could be a contraction ( spasm ) , restricting blood flow to the brain . Then , the brain tissue could not get enough oxygen and can die , such as ischemic stroke . Vasopasm can cause symptoms similar to ischemic stroke , such as weakness or loss of sensation in one part of the body , difficulty using or understanding language , vertigo , and weak coordination .
* The second Denomination : sometimes both fractions occurred , usually within a week .
Diagnosis
If people experience a sudden , severe headache that peak within seconds accompanied by various symptoms suggesting a stroke , they should immediately go to the hospital . Computed tomography ( CT ) was performed to check for bleeding . A spinal tap ( lumbar puncture ) is done if the CT is inconclusive or not available .
It can detect any blood in the cerebrospinal fluid . A spinal tap was not performed if doctors suspect that the pressure inside the skull increases . Cerebral angiography is performed as soon as possible to confirm the diagnosis and to identify the location of an aneurysm or arteriovenous malformation causing bleeding .
Magnetic resonance angiography or CT angiography may be used instead .
TREATMENT
Prognosis About 35 % of people die when they suffered a subarachnoid hemorrhage that caused an aneurysm because it resulted in extensive brain damage . The other 15 % of people die within a few weeks because of bleeding from both fractions . People who survive for 6 months but that did not do surgery for an aneurysm has 3 % chance of experiencing other denominations every year .
It looks good is when the cause is arteriovenous malformation . Sometimes , bleeding caused by minor damage that is not detected by cerebral angiography because of the damage was covered by itself . In some cases , it seems is very good . Some people recover and most or all of the physical function after subarachnoid hemorrhage .
People who have a subarachnoid hemorrhage admitted to hospital immediately . Bed rest for no reason is necessary . Analgesics such as opioids ( but not aspirin or drugs other nonsteroidal anti - inflammatory , which can exacerbate bleeding ) was given to control severe headache . Stool softeners are given to prevent struggled during defecation .
Nimodipine , a calcium channel blocker , is usually given by mouth to prevent vasospasm and subsequent stroke ischemis . Doctors perform calculations ( such as providing medicines and adjust the amount of fluid given intravenously ) to keep blood pressure at a low enough level to avoid further bleeding and high enough to keep the blood flow to the damaged parts of the brain . Sometimes , pieces of plastic tube ( shunt ) might be placed in the brain to drain the cerebrospinal fluid out of the brain . This procedure eliminates the pressure and prevent hydrochepalus .
For those who have an aneurysm , surgical procedure performed to isolate , block , or support walls of the arteries are weak and thus reduce the risk of fatal bleeding later . This procedure is difficult , and to ignore parts are used , the risk of death is high , especially for people who are in a state of unconsciousness or coma . The most appropriate time for surgery is controversial and should be decided based on the state of the person. most neurosurgeons advocate surgery within 24 hours of the onset of symptoms , before hydrocepalus and vasopasm growing .
If surgery can not be done quickly, the procedure may be delayed 10 days to reduce the risk of the operation , but then the bleeding is more likely to happen due to a longer waiting period . The procedure is normally used , called neuroendovascular operation , involves inserting a wire coiled into the aneurysm .
The rolls are mounted using a catheter inserted into an artery and infiltrated into the aneurysm . Thus , this procedure does not require opening the skull . With a slow blood flow through the aneurysm , coils increase clot formation , which closes the aneurysm and prevent rupture .
Neuroendovascular operation can often be done at the same time as cerebral angiography , when the aneurysm was diagnosed . Rarely , clamp ( clip ) placed steel lie across the aneurysm . This procedure prevents the blood into the aneurysm and removes the risk of rupture . Clamp stay in place permanently. Most clamps are placed 15 to 20 years later is affected by magnetic forces and can change position during magnetic resonance imaging ( MRI ) .
People who have this brace should inform their doctor if MRI into consideration . The new clamp can not be affected by magnetic forces .
What we need to do
After a stroke , over mengkin parents have problems , such as pressure sores , pneumonia , permanently shortened muscles ( contractures ) that restrict movement , and depression .
Older people are more likely to have been ready to experience treatment-limiting disorders in stroke . For example , they could have high blood pressure or bleeding of the stomach that prevents them from using anticoagulants to reduce the risk of blood clot . Some treatments , such as endarterectomy , is more likely to cause complications in older individuals .
However , treatment decisions should be based on the person's health than age itself. Some disorders are often teradi yangs on older people can be in touch with their recovery after stroke , such as the following below :
* People with dementia may not understand what is required by them for rehabilitation .
* People with heart failure or other heart problems could be at risk of having another stroke or a heart attack triggered by the business during rehabilitation . Good recovery is more likely when parents who have a family member or nurse for help , state of residence that provides convenience facilities ( eg , residence downstairs and close to the store ) , and the source of funds to pay for rehabilitation . Because recovery after stroke depends on many factors of medical , social , financial , and lifestyle , rehabilitation and care of the elderly should be individually designed and organized by a group of observers health practitioners ( including nurses , psychologists , and social workers such as doctors or therapists ) . Team members can also provide information about the sources and strategies to help people with stroke and their caregivers with daily life .
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