Hemoragia subarahnoidiană
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Hemoragia subarahnoidia
năMişcov Rareş, MG IV
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“When persons in good health are suddenly seized with pains in the head, and straightway are laid down speechless, and breathe with stertor, they die in seven days unless fever comes on.”
Hipocrat, “Aforisme”
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Definiţie• Patologie acută cerebrovasculară, care constă în
extravazarea sângelui în spaţiul subarahnoidian
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Epidemiologie• Vârstă: >50 ani• Incidenţă: 2-22,5/100 000• Factori de risc:
o AHCo Sex: F - status hormonalo APP: HTA, MAV, anevrisme, boli ale ţesutului conjunctiv
(Ehler-Danlos IV, Marfan, ADPKD)o CVM: fumat, consum de alcool
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Etiologie
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Patogeneză• Vasospasm cerebral (CVS)
o subangiografic/angiografic/clinico Funcţional: NO, prostaciclină/ET-1, TxA2o Structural: infiltrat inflamator acut, mioproliferare,
fibroză• Ischemia cerebrală
o Consecutiv CVS+autoreglare cerebrală afectată
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Semne şi simptome• Cefalalgie• Rigiditate nuchală • Fotofobie • Greaţă şi vărsături • Pierderea conştienţei• Crize epileptice
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Investigaţii• CT cu/fără contrast• Puncţia lombară• Angiografie cerebrală• Angio-CT• RMN, DWI, FLAIR• Angio-RMN• EKG
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Puncţia lombară
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Scale utilizate în diagnosticare
• Glasgow Coma Scale (GCS)• Hunt and Hess Scale• World Federation of Neurological Surgeons Scale
(WFNS)
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Complicaţii• Reapariţia hemoragiei• Vasospasm• Hidrocefalie• Hiponatremie• Crize epileptice• Complicaţii cardiace şi pulmonare
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Tratament• Neurochirurgical: aplicarea unui clip, lavaj cu ser
fiziologic sau rTPA al cisternelor• Endovascular: coiling• Ţinte terapeutice
o Prevenirea crizelor epileptice: fenitoină, fenobarbitalo Starea de greaţă: prometazinăo Monitorizare presiune intracraniană: dexametazonă,
manitolo Prevenirea ischemiei cerebrale: 3H Therapyo Prevenirea vasospasmului: nimodipină, nicardipinăo Managementul dureri: fentanil
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Bibliografie• H. Royden Jones Jr. - Netter’s Neurology 2nd Edition, Elsevier
Saunders, 2012• Adam Fisch – Neuroanatomy: Draw it to know it, Oxford Press,
2009• H. Richard Winn –Youman’s Neurological Surgery 6th Edition,
Elsevier Saunders, 2011• Kathryn L. McCance - Pathophysiology The Biologic Basis for
Disease in Adults and Children 6th Edition, Mosby Elsevier, 2010• J van Gijn, GJE Rinkel – Subarachnoid hemorrhage: diagnosis,
causes and management. Brain (2001), 124, 249-278• http://
emedicine.medscape.com/article/247090-overview#aw2aab6b3
• http://emedicine.medscape.com/article/344342-overview• http://www.medscape.com/viewarticle/780438_2
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Vă mulţumesc!