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The hidden twists of the brain: Why are submeningeal hemorrhages so deadly?
Subarachnoid hemorrhage (SAH) is a life-threatening condition in which bleeding occurs in the subarachnoid space of the brain, which is the space between the arachnoid membrane and the meninges of the brain. Symptoms of this condition vary, but common ones include severe headache, vomiting, decreased level of consciousness, fever, and neurological deficits. Many patients may experience neck stiffness or neck pain.
The main causes of submeningeal hemorrhage include head trauma and spontaneous bleeding, the latter of which is often caused by a ruptured aneurysm.
Risk factors for spontaneous submeningeal hemorrhage include high blood pressure, smoking, family history, alcohol abuse, and cocaine use. According to surveys, spontaneous submeningeal hemorrhage affects approximately 1 in 10,000 people each year. The incidence rate in women is higher than that in men. The incidence rate increases with age, and about 50% of people have experienced it before the age of 55. This situation.
Symptoms and diagnosis
The classic symptom of a submeningeal hemorrhage is a severe headache known as a "thunderclap headache," which is often described by patients as a pain in the brain that "feels like being kicked." Such headaches often worsen rapidly and are accompanied by other symptoms such as vomiting and convulsions. Because of these features, people with panic attacks often seek medical attention, but not everyone with similar symptoms is diagnosed with a submeningeal hemorrhage.
Of all patients admitted to the hospital with thunderclap headache, only about 10% are ultimately diagnosed with submeningeal hemorrhage.
CT scanning is an important diagnostic tool in patients with suspected submeningeal hemorrhage. According to research, CT can correctly identify up to 98.7% of cases if the scan is performed within six hours of the onset of symptoms. However, as time goes by, the effectiveness of CT decreases, and MRI scans become more sensitive.
Etiology and pathophysiology
Most submeningeal hemorrhages result from head trauma, either related to skull fractures or intracerebral contusions. However, 85% of spontaneous submeningeal hemorrhages are caused by ruptured aneurysms, most of which are located in the circle of Willis and its branches in the brain. Although most patients suffer from bleeding from small aneurysms, larger aneurysms are more likely to have a greater impact due to their higher risk of rupture.
In approximately 10-20% of patients with spontaneous submeningeal hemorrhage, the aneurysm is not detected at initial angiography.
A major complication following a submeningeal hemorrhage is vasospasm, which usually occurs between the third and seventh days after the event. Blood products in the brain stimulate smooth muscle contraction, aggravating the patient's condition and increasing the risk of slurred speech, impaired consciousness, and seizures.
Treatment and rehabilitation
Treatment of submeningeal hemorrhage relies on rapid neurosurgery or endovascular stenting. Intubation and mechanical ventilation may be required for some patients, particularly those with a reduced level of consciousness. After diagnosis, the patient needs to be admitted to the intensive care unit because 15% of patients may experience re-bleeding after admission.
Regarding the nutritional management of submeningeal hemorrhage, early feeding is a priority, and oral or nasogastric feeding is usually better than intravenous injection.
In view of the risk of rebleeding, medical staff will try to maintain the patient's systolic blood pressure between 140 and 160 mmHg to reduce the chance of rebleeding. For this purpose, drugs such as labelo or nicardipine can be used to control blood pressure.
Prevention and Screening
Although the entire population would not be screened for aneurysms, screening may be worthwhile for patients who have two or more immediate family members who have had a ruptured aneurysm. In addition, further examinations should be considered for different high-risk groups such as patients with autonomous polycystic kidney disease.
The treatment of submeningeal hemorrhage is all-encompassing, and timely measures must be taken from symptom management to control of the bleeding source. However, all of this raises a deeper question: if it cannot be identified and treated early, can the lethality of submeningeal hemorrhage be effectively prevented?
