Subarachnoid hemorrhage

868:, which can lead to a delay in obtaining a CT scan. In a 2004 study, this occurred in 12 percent of all cases and was more likely in people who had smaller hemorrhages and no impairment in their mental status. The delay in diagnosis led to a worse outcome. In some people, the headache resolves by itself, and no other symptoms are present. This type of headache is referred to as "sentinel headache", because it is presumed to result from a small leak (a "warning leak") from an aneurysm. A sentinel headache still warrants investigations with CT scan and lumbar puncture, as further bleeding may occur in the subsequent three weeks. 833: 1731:(EVD), called EG-1962, is also available. In contrast to the tablets and solution formulations of Nimodipine which require an administration every 4hrs for a total of 21 days, the sustained formulation, EG-1962, needs to be administered once directly into the ventricles. The CSF concentrations from EG-1962, however, were at least 2 orders of magnitude higher than those with oral nimodipine. These results supported a phase 3 study that demonstrated a favorable safety profile for EG-1962 but yielded inconclusive efficacy results due to notable differences in clinical outcome based on baseline disease severity. 692: 1922: 1485: 1989: 1365:

had a subarachnoid hemorrhage and people who had aneurysms detected by other means. Those having previously had a SAH were more likely to bleed from other aneurysms. In contrast, those having never bled and had small aneurysms (smaller than 10 mm) were very unlikely to have a SAH and were likely to sustain harm from attempts to repair these aneurysms. On the basis of the ISUIA and other studies, it is now recommended that people are considered for

1835:) for SAH is between 40 and 50 percent, but trends for survival are improving. Of those that survive hospitalization, more than a quarter have significant restrictions in their lifestyle, and less than a fifth have no residual symptoms whatsoever. Delay in diagnosis of minor SAH (mistaking the sudden headache for migraine) contributes to poor outcome. Factors found on admission that are associated with poorer outcome include poorer neurological grade; 6711: 999:(measuring the absorption of particular wavelengths of light) or visual examination. It is unclear which method is superior. Xanthochromia remains a reliable ways to detect SAH several days after the onset of headache. An interval of at least 12 hours between the onset of the headache and lumbar puncture is required, as it takes several hours for the hemoglobin from the red blood cells to be metabolized into 950: 50: 1012: 979:, shows evidence of bleeding in three percent of people in whom a non-contrast CT was found normal. A lumbar puncture or CT scan with contrast is therefore regarded as mandatory in people with suspected SAH when imaging is delayed to after six hours from the onset of symptoms and is negative. At least three tubes of CSF are collected. If an elevated number of 2111:, and trials with nimodipine in an attempt to prevent this complication. In 1983, the Russian neurosurgeon Zubkov and colleagues reported the first use of transluminal balloon angioplasty for vasospasm after aneurysmal SAH. The Italian neurosurgeon Dr Guido Guglielmi introduced his endovascular coil treatment in 1991. 1818:. In some studies, use of these medications was associated with a worse prognosis; although it is unclear whether this might be because the drugs themselves actually cause harm, or because they are used more often in persons with a poorer prognosis. There is a possibility of a gastric hemorrhage due to stress ulcers. 1668:(eNOS), a potent vasodilator. Both of which are produced from a series of events that begin from the inflammatory reaction caused by the products released from erythrocytes' degradation. Following subarachnoid hemorrhage, different clotting factors and blood products are released into the surrounding 4666:

Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P (2005). "International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency,

1361:(ADPKD), a hereditary kidney condition, is known to be associated with cerebral aneurysms in 8 percent of cases, but most such aneurysms are small and therefore unlikely to rupture. As a result, screening is only recommended in families with ADPKD where one family member has had a ruptured aneurysm. 983:

is present equally in all bottles, this indicates a subarachnoid hemorrhage. If the number of cells decreases per bottle, it is more likely that it is due to damage to a small blood vessel during the procedure (known as a "traumatic tap"). While there is no official cutoff for red blood cells in the

1652:

or cerebral angiography. About one third of people admitted with subarachnoid hemorrhage will have delayed ischemia, and half of those have permanent damage as a result. It is possible to screen for the development of vasospasm with transcranial Doppler every 24–48 hours. A blood flow velocity

1530:

or CT angiogram later. It is hard to predict who will have a rebleed, yet it may happen at any time and carries a dismal prognosis. After the first 24 hours have passed, rebleeding risk remains around 40 percent over the subsequent four weeks, suggesting that interventions should be aimed

1339:

has been suggested by Ogilvy and Carter to predict outcome and gauge therapy. The system consists of five grades and it assigns one point for the presence or absence of each of five factors: age greater than 50; Hunt and Hess grade 4 or 5; Fisher scale 3 or 4; aneurysm size greater than 10 mm;

787:

Cerebral vasospasm is one of the complications caused by subarachnoid hemorrhage. It usually happens from the third day after the aneurysm event, and reaches its peak on 5th to 7th day. There are several mechanisms proposed for this complication. Blood products released from subarachnoid hemorrhage

2004:

Although the group of people at risk for SAH is younger than the population usually affected by stroke, the risk still increases with age. Young people are much less likely than middle-age people (risk ratio 0.1, or 10 percent) to have a subarachnoid hemorrhage. The risk continues to rise with age

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reduction) if endovascular coiling was used as opposed to surgery. The main drawback of coiling is the possibility that the aneurysm will recur; this risk is extremely small in the surgical approach. In ISAT, 8.3 percent needed further treatment in the longer term. Hence, people who have undergone

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An aneurysm may be detected incidentally on brain imaging; this presents a conundrum, as all treatments for cerebral aneurysms are associated with potential complications. The International Study of Unruptured Intracranial Aneurysms (ISUIA) provided prognostic data both in people having previously

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The prognosis of head trauma is thought to be influenced in part by the location and amount of subarachnoid bleeding. It is difficult to isolate the effects of SAH from those of other aspects of traumatic brain injury; it is unknown whether the presence of subarachnoid blood actually worsens the

940:

In emergency department patients complaining of acute-onset headache without significant risk factors for SAH, evidence suggests that CT scanning of the head followed by CT angiography can reliably exclude SAH without the need for a lumbar puncture. The risk of missing an aneurysmal bleed as the

5286:

Macdonald RL, Hänggi D, Strange P, Steiger HJ, Mocco J, Miller M, Mayer SA, Hoh BL, Faleck HJ, Etminan N, Diringer MN, Carlson AP, Aldrich F; NEWTON Investigators. (2021). "Nimodipine pharmacokinetics after intraventricular injection of sustained-release nimodipine for subarachnoid hemorrhage".

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prognosis or whether it is merely a sign that a significant trauma has occurred. People with moderate and severe traumatic brain injury who have SAH when admitted to a hospital have as much as twice the risk of dying as those who do not. They also have a higher risk of severe disability and

2000:

of subarachnoid hemorrhage is 9.1 per 100,000 annually. Studies from Japan and Finland show higher rates in those countries (22.7 and 19.7, respectively), for reasons that are not entirely understood. South and Central America, in contrast, have a rate of 4.2 per 100,000 on average.

434:. The routine use of medications to prevent further seizures is of unclear benefit. Nearly half of people with a SAH due to an underlying aneurysm die within 30 days and about a third who survive have ongoing problems. Between ten and fifteen percent die before reaching a hospital. 1531:

at reducing this risk as soon as possible. Some predictors of early rebleeding are high systolic blood pressure, the presence of a hematoma in the brain or ventricles, poor Hunt-Hess grade (III-IV), aneurysms in the posterior circulation, and an aneurysm >10 mm in size.

1093:(GCS) is ubiquitously used for assessing consciousness. Its three specialized scores are used to evaluate SAH; in each, a higher number is associated with a worse outcome. These scales have been derived by retrospectively matching characteristics of people with their outcomes. 1738:

therapy might reduce vasospasm, but a subsequent meta-analysis including further trials did not demonstrate benefit on either vasospasm or outcomes. While corticosteroids with mineralocorticoid activity may help prevent vasospasm their use does not appear to change outcomes.

711:. It often happens in the setting of other forms of traumatic brain injury. In these cases prognosis is poorer; however, it is unclear if this is a direct result of the SAH or whether the presence of subarachnoid blood is simply an indicator of a more severe head injury. 531:(the back of the head). About one-third of people have no symptoms apart from the characteristic headache, and about one in ten people who seek medical care with this symptom are later diagnosed with a subarachnoid hemorrhage. Vomiting may be present, and 1 in 14 have 1944:, and cognitive impairment are common; 46 percent of people who have had a subarachnoid hemorrhage have cognitive impairment that affects their quality of life. Over 60 percent report frequent headaches. Aneurysmal subarachnoid hemorrhage may lead to damage of the 2016:

Genetics may play a role in a person's disposition to SAH; risk is increased three- to fivefold in first-degree relatives of people having had a subarachnoid hemorrhage. But lifestyle factors are more important in determining overall risk. These risk factors are

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Nimodipine is readily authorized in the form of tablets and solution for infusion for the prevention and treatment of complications due to vasospasm following subarachnoid hemorrhage. Another sustained formulation of nimodipine administered via an

4018: 611:

The combination of intracerebral hemorrhage and raised intracranial pressure (if present) leads to a "sympathetic surge", i.e. over-activation of the sympathetic system. This is thought to occur through two mechanisms, a direct effect on the

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coiling are typically followed up for many years afterwards with angiography or other measures to ensure recurrence of aneurysms is identified early. Other trials have also found a higher rate of recurrence necessitating further treatments.

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So-called "angiogram-negative subarachnoid hemorrhage", SAH that does not show an aneurysm with four-vessel angiography, carries a better prognosis than SAH with aneurysm, but it is still associated with a risk of ischemia, rebleeding, and

1696:(ROS) which increases and decreases the production of endothelin 1 and endothelial NOS, respectively, the issue that yields in intrinsic vasoconstriction of the neighboring blood vessels and results in cerebral ischemia if left untreated. 2005:

and is 60 percent higher in the very elderly (over 85) than in those between 45 and 55. Risk of SAH is about 25 percent higher in women over 55 compared to men the same age, probably reflecting the hormonal changes that result from the

1381:

Management involves general measures to stabilize the person while also using specific investigations and treatments. These include the prevention of rebleeding by obliterating the bleeding source, prevention of a phenomenon known as

4800:

Piotin M, Spelle L, Mounayer C, Salles-Rezende MT, Giansante-Abud D, Vanzin-Santos R, Moret J (May 2007). "Intracranial aneurysms: treatment with bare platinum coils--aneurysm packing, complex coils, and angiographic recurrence".

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and will correctly identify 98.7% of cases within six hours of the onset of symptoms. A CT scan can rule out the diagnosis in someone with a normal neurological exam if done within six hours. Its efficacy declines thereafter, and

604:. Seizures are more common if the hemorrhage is from an aneurysm; it is otherwise difficult to predict the site and origin of the hemorrhage from the symptoms. SAH in a person known to have seizures is often diagnostic of a 4444:

Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond J (September 2010). "Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy".

3603:

McCormack RF, Hutson A (April 2010). "Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan?".

1550:(opening of the skull) to locate the aneurysm, followed by the placement of clips around the neck of the aneurysm. Coiling is performed through the large blood vessels (endovascularly): a catheter is inserted into the 6701: 5344:

Carlson AP, Hänggi D, Wong GK, Etminan N, Mayer SA, Aldrich F, Diringer MN, Schmutzhard E, Faleck HJ, Ng D, Saville BR, Bleck T, Grubb R Jr, Miller M, Suarez JI, Proskin HM, Macdonald RL; NEWTON Investigators (2020).

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Servadei F, Murray GD, Teasdale GM, et al. (February 2002). "Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries".

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Spontaneous SAH occurs in about one per 10,000 people per year. Females are more commonly affected than males. While it becomes more common with age, about 50% of people present under 55 years old. It is a form of

2229:"Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds" 682:

While thunderclap headache is the characteristic symptom of subarachnoid hemorrhage, less than 10% of those with concerning symptoms have SAH on investigations. A number of other causes may need to be considered.

6579: 6556: 916:

After a subarachnoid hemorrhage is confirmed, its origin needs to be determined. If the bleeding is likely to have originated from an aneurysm (as determined by the CT scan appearance), the choice is between

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and a local release of inflammatory mediators that circulate to the peripheral circulation where they activate the sympathetic system. As a consequence of the sympathetic surge there is a sudden increase in

1754:(excess fluid in the circulation), and hemodilution (mild dilution of the blood). Evidence for this approach is inconclusive; no randomized controlled trials have been undertaken to demonstrate its effect. 5548:

Kassell NF, Peerless SJ, Durward QJ, Beck DW, Drake CG, Adams HP (September 1982). "Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension".

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and others lead to microthrombosis around near vessels that leads to extrinsic vasoconstriction of these vessels. Besides that extrinsic vasoconstriction, the erythrocytes' degradation products like;

1711:

when taken by mouth improves outcome if given between the fourth and twenty-first day after the bleeding, even if it does not reduce the amount of vasospasm detected on angiography. It is the only

5285: 6699: 1928:

of a case with subarachnoid hemorrhage. The arachnoid mater is left in place on the exterior surface, containing extensive hemorrhage that also fills the sulci, as detailed in magnified image.

864:, in which bleeding occurs within the brain itself, is twice as common as SAH and is often misdiagnosed as the latter. It is not unusual for SAH to be initially misdiagnosed as a migraine or 5465:"Effect of statin treatment on vasospasm, delayed cerebral ischemia, and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis update" 679:(weakness of one side of the body). SAH is a frequent occurrence in traumatic brain injury and carries a poor prognosis if it is associated with deterioration in the level of consciousness. 2060:, the existence of cerebral aneurysms and the fact that they could rupture was not established until the 18th century. The associated symptoms were described in more detail in 1886 by 5963:

Lanterna LA, Ruigrok Y, Alexander S, Tang J, Biroli F, Dunn LT, Poon WS (August 2007). "Meta-analysis of APOE genotype and subarachnoid hemorrhage: clinical outcome and delayed ischemia".

5631:

Rosengart AJ, Huo JD, Tolentino J, Novakovic RL, Frank JI, Goldenberg FD, Macdonald RL (August 2007). "Outcome in patients with subarachnoid hemorrhage treated with antiepileptic drugs".

1898:, hydrocephalus, and longer stays in the intensive care unit. More than 90 percent of people with traumatic subarachnoid bleeding and a Glasgow Coma Score over 12 have a good outcome. 1456:

People with poor clinical grade on admission, acute neurologic deterioration, or progressive enlargement of ventricles on CT scan are, in general, indications for the placement of an

2076:(1890–1978) gave a complete account of all major symptoms of subarachnoid hemorrhage, and he coined the term "spontaneous subarachnoid hemorrhage". Symonds also described the use of 848:

As only 10 percent of people admitted to the emergency department with a thunderclap headache are having an SAH, other possible causes are usually considered simultaneously, such as

442:

and comprises about 5 percent of all strokes. Surgery for aneurysms was introduced in the 1930s. Since the 1990s many aneurysms are treated by a less invasive procedure called

6700: 1593:

and posterior cerebral artery are hard to reach surgically and are more accessible for endovascular management. These approaches are based on general experience, and the only

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was applied to aneurysm treatment in 1972 in order to further improve outcomes. The 1980s saw the introduction of triple H therapy as a treatment for delayed ischemia due to

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and have aneurysms that are highly likely to rupture. Moreover, there is only limited evidence that endovascular treatment of unruptured aneurysms is actually beneficial.

1776:(obstruction of the flow of cerebrospinal fluid) may complicate SAH in both the short and long term. It is detected on CT scanning, on which there is enlargement of the 3229:

Santos-Franco JA, Zenteno M, Lee A (April 2008). "Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options".

4624:

Guglielmi G, Viñuela F, Dion J, Duckwiler G (July 1991). "Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience".

1585:

In general, the decision between clipping and coiling is made on the basis of the location of the aneurysm, its size and the condition of the person. Aneurysms of the

2041:

and the risk of non-traumatic SAH, though confirmation of this association is hindered by a lack of studies. Approximately 4 percent of aneurysmal bleeds occur after

380:. Neck stiffness or neck pain are also relatively common. In about a quarter of people a small bleed with resolving symptoms occurs within a month of a larger bleed. 4996:

Suhardja A. (2004). "Mechanisms of disease: roles of nitric oxide and endothelin-1 in delayed cerebral vasospasm produced by aneurysmal subarachnoid hemorrhage".

6494:

Zubkov YN, Nikiforov BM, Shustin VA (September–October 1984). "Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH".

5243:

Vergouwen MD, Vermeulen M, Roos YB (December 2006). "Effect of nimodipine on outcome in patients with traumatic subarachnoid haemorrhage: a systematic review".

4939:

Kolias AG, Sen J, Belli A. (2009). "Pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage: putative mechanisms and novel approaches".

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due to lack of oxygen in parts of the brain. It can be fatal if severe. Delayed ischemia is characterized by new neurological symptoms, and can be confirmed by

5208:

Allen GS, Ahn HS, Preziosi TJ, et al. (March 1983). "Cerebral arterial spasm--a controlled trial of nimodipine in patients with subarachnoid hemorrhage".

4152:

Fisher CM, Kistler JP, Davis JM (January 1980). "Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning".

2025:. Having smoked in the past confers a doubled risk of SAH compared to those who have never smoked. Some protection of uncertain significance is conferred by 527:(a headache described as "like being kicked in the head", or the "worst ever", developing over seconds to minutes). This headache often pulsates towards the 1901:

There is also modest evidence that genetic factors influence the prognosis in SAH. For example, having two copies of ApoE4 (a variant of the gene encoding

1757:

If the symptoms of delayed ischemia do not improve with medical treatment, angiography may be attempted to identify the sites of vasospasms and administer

7382: 3137:

Armin SS, Colohan AR, Zhang JH (June 2006). "Traumatic subarachnoid hemorrhage: our current understanding and its evolution over the past half century".

737:. About half of these are attributed to non-aneurysmal perimesencephalic hemorrhage, in which the blood is limited to the subarachnoid spaces around the 6763: 1952:, two areas of the brain that play a central role in hormonal regulation and production. More than a quarter of people with a previous SAH may develop 3652: 1526:

may benefit from urgent surgical removal of the blood or occlusion of the bleeding site. The remainder are stabilized more extensively and undergo a

6057:"Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis" 741:(i.e. mesencephalon). In these, the origin of the blood is uncertain. The remainder are due to other disorders affecting the blood vessels (such as 5449: 5394: 5330: 5191: 5128: 4982: 3864: 4761:"Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT)" 726:

and its branches. While most cases are due to bleeding from small aneurysms, larger aneurysms (which are less common) are more likely to rupture.

1574:

in the aneurysm, obliterating it. The decision as to which treatment is undertaken is typically made by a multidisciplinary team consisting of a

675:

Subarachnoid hemorrhage may also occur in people who have had a head injury. Symptoms may include headache, decreased level of consciousness and

3829:

Gussak I, Bjerregaard P, Egan TM, Chaitman BR. (1995). "ECG phenomenon called the J wave. History, pathophysiology, and clinical significance".

3561:"Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache" 1355:. However, if someone has two or more first-degree relatives who have had an aneurysmal subarachnoid hemorrhage, screening may be worthwhile. 1061:, where the S point, also known as the J point, has a myocardial infarction-like elevation. J waves or Osborn waves, which represent an early 4026: 3985: 3312:(January 2009). "Pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage: putative mechanisms and novel approaches". 2091:

then working in Edinburgh. He introduced the wrapping of aneurysms in the 1930s, and was an early pioneer in the use of angiograms. American

1723:

have been studied, but are not presently recommended; neither is there any evidence that shows benefit if nimodipine is given intravenously.

2915:

Wartenberg KE, Mayer SA (April 2006). "Medical complications after subarachnoid hemorrhage: new strategies for prevention and management".

4189:"Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited" 3062: 2872:

Lee VH, Oh JK, Mulvagh SL, Wijdicks EF (2006). "Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage".

4480: 1409:

may be preferable, especially since 15 percent may have further bleeding soon after admission. Nutrition is an early priority, mouth or

5588:, Albon H, Morgan L, Petzold A, Kitchen N (October 2003). "Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage". 1597:

directly comparing the different modalities was performed in relatively well people with small (less than 10 mm) aneurysms of the

5674:

Naval NS, Stevens RD, Mirski MA, Bhardwaj A (February 2006). "Controversies in the management of aneurysmal subarachnoid hemorrhage".

1854:; and higher age. Factors that carry a worse prognosis during the hospital stay include occurrence of delayed ischemia resulting from 7461: 3509:"Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis" 792:

pathway causing the release of calcium ions from intracellular storage, resulting in smooth muscle contraction of cerebral arteries.

779:, usually caused by trauma, can lead to subarachnoid hemorrhage if the dissection involves the part of the vessel inside the skull. 1719:

subarachnoid hemorrhage, nimodipine does not affect long-term outcome, and is not recommended. Other calcium channel blockers and

1460:

by a neurosurgeon. The external ventricular drain may be inserted at the bedside or in the operating room. In either case, strict

57:

CT scan of the brain showing subarachnoid hemorrhage as a white area in the center (marked by the arrow) and stretching into the

6420:"Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial" 7416: 6756: 6106:"Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review" 1742:

A protocol referred to as "triple H" is often used as a measure to treat vasospasm when it causes symptoms; this is the use of

509: 7217: 5856: 5091: 4109:

Hunt WE, Hess RM (January 1968). "Surgical risk as related to time of intervention in the repair of intracranial aneurysms".

2772: 2698: 2666: 2292: 2048:

Overall, about 1 percent of all people have one or more cerebral aneurysms. Most of these are small and unlikely to rupture.

1358: 6383:

Krayenbühl HA, Yaşargil MG, Flamm ES, Tew JM (December 1972). "Microsurgical treatment of intracranial saccular aneurysms".

3668:"Spectrophotometry or visual inspection to most reliably detect xanthochromia in subarachnoid hemorrhage: systematic review" 3360:

Teunissen LL, Rinkel GJ, Algra A, van Gijn J (March 1996). "Risk factors for subarachnoid hemorrhage: a systematic review".

2480: 7015: 5506:"Corticosteroids in the Management of Hyponatremia, Hypovolemia, and Vasospasm in Subarachnoid Hemorrhage: A Meta-Analysis" 1788:. Relief of hydrocephalus can lead to an enormous improvement in a person's condition. Fluctuations in blood pressure and 1605:(together the "anterior circulation"), who constitute about 20 percent of all people with aneurysmal SAH. This trial, the 937:

on a CT scan) to identify aneurysms. Catheter angiography also offers the possibility of coiling an aneurysm (see below).

7471: 6602: 742: 605: 5141: 4882:

Dorhout Mees SM, Rinkel GJ, Feigin VL, Algra A, van den Bergh WM, Vermeulen M, van Gijn J (July 2007). Rinkel GJ (ed.).

1780:. If the level of consciousness is decreased, drainage of the excess fluid is performed by therapeutic lumbar puncture, 1538:

is identified on angiography, two measures are available to reduce the risk of further bleeding from the same aneurysm:

7010: 6811: 4345: 4017:

Schatz SW, Morley T, Fleming JR, Geisler WO, Tator CH, Tasker RR, Gentili F, Vandewater SL, Lougheed WM (August 1999).

3641:"Evidence-Based Approach to Diagnosis and Management of Aneurysmal Subarachnoid Hemorrhage in the Emergency Department" 1957: 5347:"Single-Dose Intraventricular Nimodipine Microparticles Versus Oral Nimodipine for Aneurysmal Subarachnoid Hemorrhage" 7466: 6801: 6749: 6716: 4230:"A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies" 3712:"Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage" 3056: 5717:

Liu KC, Bhardwaj A (2007). "Use of prophylactic anticonvulsants in neurologic critical care: a critical appraisal".

1251:

This scale has been modified by Claassen and coworkers, reflecting the additive risk from SAH size and accompanying

664:, where a process of increased pressure within the pulmonary circulation causes leaking of fluid from the pulmonary 570:(bleeding into the eyeball) may occur in response to the raised pressure: subhyaloid hemorrhage (bleeding under the 7476: 7317: 7184: 1499:

with a residual aneurysmal sac. The person was a 34-year-old woman initially treated for a subarachnoid hemorrhage.

857: 489: 369: 281: 178: 4403:

Wiebers DO, et al. (International Study of Unruptured Intracranial Aneurysms Investigators) (December 1998).

657:(in 3 percent of cases) may occur rapidly after the onset of hemorrhage. A further consequence of this process is 641:. The consequences of this sympathetic surge can be sudden, severe, and are frequently life-threatening. The high 422:

may be required to lower the blood pressure until repair can occur. Efforts to treat fevers are also recommended.

7352: 6962: 6806: 6156:"Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends" 5039:

Pluta RM. (2005). "Delayed cerebral vasospasm and nitric oxide: review, new hypothesis, and proposed treatment".

1464:

must be maintained during insertion. In people with aneurysmal subarachnoid hemorrhage the EVD is used to remove

926: 1100:

and Cannell in 1956 and referred to as the Botterell Grading Scale. This was modified by Hunt and Hess in 1968:

1022:

changes are relatively common in subarachnoid hemorrhage, occurring in 40–70 percent of cases. They may include

1660:

The pathogenesis of cerebral vasospasm following subarachnoid hemorrhage is attributed to the higher levels of

1255:(0 – none; 1 – minimal SAH w/o IVH; 2 – minimal SAH with IVH; 3 – thick SAH w/o IVH; 4 – thick SAH with IVH);. 601: 4838:"Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils" 4282:"A proposed comprehensive grading system to predict outcome for surgical management of intracranial aneurysms" 2461:"Historical perspective. Electrothrombosis of saccular aneurysms via endovascular approach: part 1 and part 2" 1015:

ECG changes resembling those of an STEMI in a woman who had an acute CNS injury from a subarachnoid hemorrhage

7161: 6967: 1941: 1602: 1589:

and its related vessels are hard to reach with angiography and tend to be amenable to clipping. Those of the

450: 22: 5410:"Intraventricular Nimodipine for Aneurysmal Subarachnoid Hemorrhage: Results of the NEWTON Phase 1/2a Study" 4056: 2045:

and 10 percent of people with SAH are bending over or lifting heavy objects at the onset of their symptoms.

407:

is also required. After confirmation further tests are usually performed to determine the underlying cause.

6826: 1969: 1712: 1425:

may impact on the mental status and thus interfere with the ability to monitor the level of consciousness.

1389:

Stabilizing the person is the first priority. Those with a depressed level of consciousness may need to be

638: 3802:

De Sweit J. (1972). "Changes simulating hypothermia in the electrocardiogram in subarachnoid hemorrhage".

3640: 2495: 7255: 7250: 7100: 6894: 5808:"Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage" 1891: 1594: 1352: 1252: 776: 4712:"Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage" 1351:

for aneurysms is not performed on a population level; because they are relatively rare, it would not be

6936: 6869: 4071: 1728: 1610: 1457: 1259: 905: 617: 505: 481: 474: 1073:

surge released in patients with subarachnoid hemorrhage or brain damage, the issue that might lead to

7398: 7210: 7005: 6972: 6864: 6854: 6735: 1543: 1507:

somewhere between 140 and 160 mmHg is generally recommended. Medications to achieve this may include

1496: 501: 7357: 5121: 2515:"Pseudo-Subarachnoid Hemorrhage: A Potential Imaging Pitfall Associated with Diffuse Cerebral Edema" 1405:, and Glasgow Coma Scale are monitored frequently. Once the diagnosis is confirmed, admission to an 7428: 7302: 7092: 7043: 6890: 6613: 5883:"Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies" 4710:

Lindgren A, Vergouwen MD, van der Schaaf I, Algra A, Wermer M, Clarke MJ, Rinkel GJ (August 2018).

1997: 1797: 1598: 1074: 871:

The initial steps for evaluating a person with a suspected subarachnoid hemorrhage are obtaining a

861: 821: 626: 295: 2716:"A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage" 7411: 7377: 7334: 7242: 7134: 7038: 6952: 6881: 6772: 5142:

Xie A, Aihara Y, Bouryi VA, Nikitina E, Jahromi BS, Zhang ZD, Takahashi M, Macdonald RL. (2007).

3976: 2227:

Carpenter CR, Hussain AM, Ward MJ, Zipfel GJ, Fowler S, Pines JM, Sivilotti ML (September 2016).

1895: 1815: 1707:

from entering smooth muscle cells, has been proposed for prevention. The calcium channel blocker

1700: 1693: 1614: 1504: 1442: 984:

CSF no documented cases have occurred at less than "a few hundred cells" per high-powered field.

708: 462: 427: 185: 7433: 7423: 7307: 7234: 4228:

Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers JC (November 1988).

3046: 1906: 1859: 1781: 1586: 1523: 1410: 1394: 567: 555: 268: 6653: 5881:

Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, Anderson CS (December 2005).

3927:

Rosen DS, Macdonald RL (2005). "Subarachnoid hemorrhage grading scales: a systematic review".

832: 7481: 7367: 7362: 7324: 7156: 6885: 5443: 5388: 5324: 5185: 4976: 4488: 3858: 1977: 1921: 1840: 1836: 1789: 1641: 1469: 1430: 1366: 1336: 691: 563: 497: 58: 6741: 7486: 7312: 7203: 6916: 6731: 6008:"Hyperglycemia and clinical outcome in aneurysmal subarachnoid hemorrhage: a meta-analysis" 4523: 1673: 1649: 1609:(ISAT), showed that in this group the likelihood of death or being dependent on others for 1527: 1484: 1426: 1414: 1348: 1170: 918: 876: 524: 443: 415: 365: 170: 6205:"Cholesterol levels and risk of hemorrhagic stroke: a systematic review and meta-analysis" 8: 7329: 7292: 7179: 7057: 6995: 6906: 6583: 6006:

Kruyt ND, Biessels GJ, de Haan RJ, Vermeulen M, Rinkel GJ, Coert B, Roos YB (June 2009).

5074:

Zhou Y, Martin RD, Zhang JH. (2011). "Advances in Experimental Subarachnoid Hemorrhage".

2556: 2022: 1965: 1848: 1811: 1669: 1539: 1465: 1406: 1031: 1019: 964: 900: 892: 797: 400: 392: 233: 4527: 3277:"Drug treatment of cerebral vasospasm after subarachnoid hemorrhage following aneurysms" 1847:; more blood and larger aneurysm on the initial CT scan; location of an aneurysm in the 1258:

The World Federation of Neurosurgeons (WFNS) classification uses Glasgow coma score and

7344: 7287: 7118: 6957: 6519: 6444: 6419: 6360: 6335: 6180: 6155: 6081: 6056: 6037: 5988: 5976: 5940: 5923: 5899: 5882: 5824: 5807: 5742: 5699: 5687: 5656: 5613: 5376: 5312: 5268: 5173: 5109: 5021: 4964: 4921: 4908: 4883: 4854: 4837: 4736: 4711: 4692: 4598: 4573: 4546: 4511: 4405:"Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention" 4254: 4229: 4134: 4091: 3952: 3909: 3784: 3741: 3538: 3489: 3399: 3337: 3254: 3211: 3162: 3027: 2984: 2940: 2928: 2897: 2854: 2740: 2715: 2623: 2596: 2531: 2433: 2408: 2384: 2253: 2228: 2042: 1863: 1777: 1473: 1185: 1090: 968: 772: 760: 669: 646: 630: 551: 485: 431: 349: 195: 165: 6596: 6592: 5601: 5256: 4680: 3842: 3684: 3667: 3577: 3560: 3015: 2806: 2789: 2372: 1784:(a temporary device inserted into one of the ventricles), or occasionally a permanent 1096:

The first widely used scale for neurological condition following SAH was published by

7438: 7270: 7265: 7077: 7072: 6911: 6859: 6624: 6511: 6476: 6449: 6400: 6365: 6270: 6226: 6185: 6127: 6104:

Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha A (September 2007).

6086: 6029: 5980: 5945: 5904: 5852: 5829: 5788: 5734: 5691: 5648: 5605: 5566: 5562: 5527: 5486: 5431: 5380: 5368: 5316: 5304: 5260: 5225: 5165: 5097: 5087: 5056: 5052: 5013: 4956: 4913: 4859: 4818: 4782: 4741: 4684: 4641: 4603: 4589: 4551: 4462: 4426: 4382: 4377: 4361:"Follow-up of intracranial aneurysms in autosomal-dominant polycystic kidney disease" 4360: 4337: 4303: 4298: 4281: 4259: 4210: 4169: 4165: 4126: 4083: 3999: 3944: 3901: 3846: 3811: 3776: 3733: 3689: 3621: 3617: 3582: 3530: 3481: 3429: 3377: 3329: 3246: 3203: 3154: 3106: 3052: 3019: 2976: 2972: 2932: 2889: 2811: 2768: 2745: 2694: 2662: 2628: 2577: 2536: 2472: 2438: 2376: 2288: 2258: 2196: 2034: 1933: 1909:) seems to increase risk for delayed ischemia and a worse outcome. The occurrence of 1743: 1720: 1535: 1461: 996: 976: 715: 700: 650: 613: 571: 512: 477: 388: 353: 252: 221: 191: 149: 6588: 5767:"Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage" 5746: 5703: 5660: 5617: 5272: 5025: 4968: 4696: 4512:"Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: a meta-analysis" 4095: 3956: 3745: 3493: 3464:

Suarez JI, Tarr RW, Selman WR (January 2006). "Aneurysmal subarachnoid hemorrhage".

3341: 3166: 2988: 2944: 2901: 2858: 2388: 7282: 6831: 6821: 6784: 6664: 6523: 6503: 6439: 6431: 6392: 6355: 6347: 6316: 6260: 6216: 6175: 6167: 6117: 6076: 6068: 6041: 6019: 5992: 5972: 5935: 5894: 5819: 5778: 5726: 5683: 5640: 5597: 5585: 5558: 5517: 5476: 5421: 5358: 5296: 5252: 5217: 5177: 5155: 5079: 5048: 5005: 4948: 4925: 4903: 4899: 4895: 4849: 4810: 4772: 4731: 4727: 4723: 4676: 4633: 4593: 4585: 4541: 4531: 4454: 4416: 4372: 4293: 4249: 4241: 4200: 4161: 4138: 4118: 4075: 4035: 3989: 3936: 3913: 3891: 3838: 3788: 3768: 3723: 3679: 3613: 3572: 3542: 3520: 3473: 3419: 3403: 3369: 3321: 3309: 3288: 3258: 3238: 3193: 3146: 3096: 3031: 3011: 2968: 2924: 2881: 2844: 2801: 2735: 2727: 2618: 2608: 2569: 2526: 2428: 2420: 2368: 2248: 2240: 2188: 1913:(high blood sugars) after an episode of SAH confers a higher risk of poor outcome. 1902: 1894:, and traumatic SAH has been correlated with other markers of poor outcome such as 1851: 1654: 1563: 1402: 1053:

or Osborn waves, which are positive deflections that occur at the junction between

865: 733:

In 15–20 percent of cases of spontaneous SAH, no aneurysm is detected on the first

723: 634: 589: 559: 470: 74: 3215: 3182:"Aspirin and Risk of Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis" 2056:

While the clinical picture of subarachnoid hemorrhage may have been recognized by

1200:

The Fisher Grade classifies the appearance of subarachnoid hemorrhage on CT scan.

6816: 6618: 6320: 6221: 6204: 6024: 6007: 5783: 5766: 5481: 5464: 5363: 5346: 5144:"Novel mechanism of endothelin-1-induced vasospasm after subarachnoid hemorrhage" 4777: 4760: 4536: 4019:"E. Harry Botterell: A Series of Papers Commemorating his Life and Contributions" 3525: 3508: 3198: 3181: 2460: 2087:

The first surgical intervention was performed by Norman Dott, who was a pupil of

2077: 2073: 2030: 2018: 1953: 1949: 1677: 1665: 1370: 1097: 1023: 960: 880: 872: 841: 837: 789: 661: 593: 583: 404: 261: 6670: 6667: 5504:

Mistry AM, Mistry EA, Ganesh Kumar N, Froehler MT, Fusco MR, Chitale RV (2016).

5221: 5083: 4421: 4404: 4359:

Gibbs GF, Huston J, Qian Q, Kubly V, Harris PC, Brown RD, Torres VE (May 2004).

1800:

occur in about half the hospitalized persons with SAH and may worsen prognosis.

6990: 6836: 6629: 6396: 6351: 5644: 4637: 4122: 2849: 2830: 2496:"Pseudosubarachnoid hemorrhage | Radiology Reference Article | Radiopaedia.org" 2088: 2065: 2026: 1961: 1940:. Even in those who have made good neurological recovery, anxiety, depression, 1832: 1785: 1681: 1590: 1579: 1559: 1551: 1446: 1438: 1417:

routes. In general, pain control is restricted to less-sedating agents such as

1078: 1070: 1066: 1062: 992: 980: 793: 704: 654: 622: 550:

Neck stiffness usually presents six hours after initial onset of SAH. Isolated

466: 7000: 6573: 6569: 5730: 4814: 4079: 4040: 3940: 3828: 3772: 3293: 3276: 3242: 2885: 2192: 1992:

Average number of people with SAH per 100,000 person-years, broken down by age

1761:

medication (drugs that relax the blood vessel wall) directly into the artery.

7455: 6435: 6171: 6122: 6105: 5300: 5160: 5143: 3559:

Godwin SA, Cherkas DS, Panagos PD, Shih RD, Byyny R, Wolf SJ (October 2019).

3150: 3101: 3085:"Subarachnoid hemorrhage without detectable aneurysm. A review of the causes" 3084: 2731: 2081: 1910: 1879: 1875: 1844: 1773: 1689: 1618: 1139: 1054: 1049:

changes that could be found in patients with subarachnoid hemorrhage, is the

988: 953: 934: 809: 801: 764: 575: 6565: 6265: 6248: 5426: 5409: 4458: 4325: 4245: 3994: 3971: 3728: 3711: 3373: 703:

such as a blow to the head. Traumatic SAH usually occurs near the site of a

695:

Circle of Willis with the most common locations of ruptured aneurysms marked

586:(occurring in 3–13 percent of cases) and is more common in more severe SAH. 7406: 7226: 6369: 6230: 6189: 6154:

de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ (December 2007).

6131: 6090: 6033: 5984: 5949: 5908: 5833: 5792: 5738: 5695: 5652: 5609: 5531: 5490: 5435: 5372: 5308: 5264: 5169: 5101: 5060: 5017: 4960: 4917: 4863: 4822: 4786: 4745: 4688: 4607: 4555: 4466: 4386: 4341: 4214: 4087: 4003: 3948: 3905: 3896: 3879: 3780: 3737: 3693: 3625: 3586: 3534: 3485: 3433: 3424: 3407: 3333: 3250: 3207: 3158: 3048:

Critical care medicine: principles of diagnosis and management in the adult

3023: 2980: 2936: 2893: 2815: 2749: 2632: 2581: 2540: 2476: 2380: 2359:

van Gijn J, Kerr RS, Rinkel GJ (January 2007). "Subarachnoid haemorrhage".

2262: 2200: 2104: 2096: 2092: 1945: 1751: 1747: 1661: 1645: 1575: 1120: 1039: 1035: 972: 930: 883:

and possibly a lumbar puncture is required to confirm or exclude bleeding.

817: 813: 805: 768: 642: 465:

that mimics a true subarachnoid hemorrhage. This occurs in cases of severe

411: 291: 154: 6515: 6480: 6453: 6404: 6274: 6103: 6072: 5570: 5229: 5009: 4645: 4430: 4307: 4263: 4205: 4188: 4173: 4130: 3850: 3815: 3381: 3110: 2442: 2424: 7387: 6719:

was created from a revision of this article dated 9 August 2008

6648: 4574:"Intracranial Aneurysm of the Internal Carotid Artery Cured by Operation" 3477: 2069: 2057: 2038: 1808: 1762: 1758: 1703:, thought to be able to prevent the spasm of blood vessels by preventing 1512: 1488: 1242: 896: 746: 676: 665: 454: 384: 361: 228: 217: 2573: 879:. The diagnosis cannot be made on clinical grounds alone and in general 7372: 7297: 6928: 6846: 6507: 5765:

Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL (August 2007).

3002:

Schwedt TJ, Matharu MS, Dodick DW (July 2006). "Thunderclap headache".

2514: 2244: 1708: 1634: 1571: 1547: 1450: 1390: 1058: 849: 658: 579: 493: 423: 403:

of the head if done within six hours of symptom onset. Occasionally, a

311: 302: 273: 241: 6548: 5764: 5522: 5505: 4952: 3759:

Nguyen H, Zaroff JG (November 2009). "Neurogenic stunned myocardium".

3325: 2613: 1988: 1142: 597: 7110: 6659: 2108: 2100: 2061: 2006: 1882:

in the brain), however, has a very low rate of rebleeding or delayed

1855: 1793: 1765:(opening the constricted area with a balloon) may also be performed. 1685: 1630: 1508: 1434: 1383: 1135: 1000: 734: 544: 536: 419: 357: 318: 307: 209:

Traumatic, spontaneous (aneurysmal, nonaneurysmal, perimesencephalic)

158: 4709: 4187:

Claassen J, Bernardini GL, Kreiter K, et al. (September 2001).

3180:

Phan K, Moore JM, Griessenauer CJ, Ogilvy CS, Thomas AJ (May 2017).

7148: 6901: 3666:

Chu K, Hann A, Greenslade J, Williams J, Brown A (September 2014).

3051:(4th ed.). Philadelphia, PA: Elsevier/Saunders. p. 1154. 2010: 1996:

According to a review of 51 studies from 21 countries, the average

1883: 1692:

lead to neuroinflammation that in turn increases the production of

1638: 1567: 1519: 1422: 922: 853: 738: 722:

in the brain that becomes enlarged. They tend to be located in the

345: 277: 174: 4799: 824:

innervating cerebral arteries is also thought to cause vasospasm.

7033: 6467:

Zubkov I, Nikiforov BM, Shustin VA (September–October 1983). "".

5924:"Life expectancy after perimesencephalic subarachnoid hemorrhage" 2513:

Given CA, Burdette JH, Elster AD, Williams DW (1 February 2003).

2179:

Abraham MK, Chang WW (November 2016). "Subarachnoid Hemorrhage".

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Pickard JD, Murray GD, Illingworth R, et al. (March 1989).

6246: 5503: 5407: 3408:"Initial misdiagnosis and outcome after subarachnoid hemorrhage" 949: 49: 6776: 6560: 5463:

Vergouwen MD, de Haan RJ, Vermeulen M, Roos YB (January 2010).

3398:

Kowalski RG, Claassen J, Kreiter KT, Bates JE, Ostapkovich ND,

2554:

Marder CP, Narla V, Fink JR, Tozer Fink KR (26 December 2013).

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Dubosh NM, Bellolio MF, Rabinstein AA, Edlow JA (March 2016).

2037:. There is likely an inverse relationship between total serum 1069:

of the heart ventricles, are thought to be caused by the high

840:

in progress. A large area on the back has been washed with an

127: 107: 6793: 6771: 6153: 6005: 5462: 4884:"Calcium antagonists for aneurysmal subarachnoid haemorrhage" 4881: 4623: 4487:. American Association of Neuroscience Nurses. Archived from 4481:"Care of the Patient with Anuerysmal Subarachnoid Hemorrhage" 4057:"Subarachnoid hemorrhage grading scales: a systematic review" 3506: 2836:

Continuing Education in Anaesthesia, Critical Care & Pain

2790:"Acute neurocardiogenic injury after subarachnoid hemorrhage" 1973: 1867: 1831:

SAH is often associated with a poor outcome. The death rate (

1566:) that supply the brain. When the aneurysm has been located, 1555: 1398: 1189: 750: 592:

abnormalities (affected eye looking downward and outward and

373: 6054: 5962: 5806:

Naidech AM, Kreiter KT, Janjua N, et al. (March 2005).

5073: 3397: 3359: 1936:, mood disturbances, and other related symptoms, are common 1011: 6876: 3179: 2788:

Banki NM, Kopelnik A, Dae MW, et al. (November 2005).

2767:(2nd ed.). Oxford University Press. pp. 408–409. 2693:. Vol. 3 (Fourth ed.). Oxford. pp. 1032–34. 2512: 540: 121: 89: 6382: 6307:

Symonds CP (1924). "Spontaneous subarachnoid hemorrhage".

6247:

Longstreth WT, Koepsell TD, Yerby MS, van Belle G (1985).

5673: 5547: 4938: 4667:

seizures, rebleeding, subgroups, and aneurysm occlusion".

4016: 3710:

Cruickshank A, Auld P, Beetham R, et al. (May 2008).

2226: 1804:

occur during the hospital stay in about a third of cases.

1169:

Stuporous; moderate to severe hemiparesis; possibly early

133: 4836:

Raymond J, Guilbert F, Weill A, et al. (June 2003).

4186: 3665: 2553: 1633:, in which the blood vessels constrict and thus restrict 1046: 543:

may be present, as may neck stiffness and other signs of

130: 98: 83: 6417: 6288:

Bramwell B (1886). "Spontaneous meningeal haemorrhage".

6055:

Powell J, Kitchen N, Heslin J, Greenwood R (June 2002).

4227: 3558: 1715:(FDA)-approved drug for treating cerebral vasospasm. In 1089:

There are several grading scales available for SAH. The

4759:

Campi A, Ramzi N, Molyneux AJ, et al. (May 2007).

4443: 3228: 2713: 2283:

Longmore M, Wilkinson I, Turmezei T, Cheung CK (2007).

1340:

and posterior circulation aneurysm 25 mm or more.

6493: 6466: 5880: 5242: 3880:"The pathway of ventricular depolarization in the dog" 3709: 3082: 2957: 578:

of the eye) and vitreous hemorrhage may be visible on

449:

A true subarachnoid hemorrhage may be confused with a

3083:

Rinkel GJ, van Gijn J, Wijdicks EF (September 1993).

446:, which is carried out through a large blood vessel. 399:

use. Generally, the diagnosis can be determined by a

104: 101: 80: 77: 6538: 5846: 5805: 4835: 4665: 4358: 3001: 2871: 2021:, hypertension (high blood pressure), and excessive 1862:, or intraventricular hemorrhage (bleeding into the 1664:, a potent vasoconstrictor, and the lower levels of 1241:

Diffuse or none with intraventricular hemorrhage or

908:(MRI) is more sensitive than CT after several days. 110: 95: 86: 7383:

Spinal cord injury without radiographic abnormality

6469:

Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko

5583: 3972:"Editorial: Subarachnoid hemorrhage grading scales" 3877: 3270: 3268: 2828: 124: 118: 115: 92: 6203:Wang X, Dong Y, Qi X, Huang C, Hou L (July 2013). 6160:Journal of Neurology, Neurosurgery, and Psychiatry 6061:Journal of Neurology, Neurosurgery, and Psychiatry 4758: 4234:Journal of Neurology, Neurosurgery, and Psychiatry 4151: 2720:Journal of Neurology, Neurosurgery, and Psychiatry 2714:McCarron MO, Alberts MJ, McCarron P (March 2004). 2555: 2413:Journal of Neurology, Neurosurgery, and Psychiatry 2358: 1886:, and the prognosis of this subtype is excellent. 1644:(referred to as "delayed ischemia") and permanent 714:In 85 percent of spontaneous cases the cause is a 600:(loss of movement) may indicate bleeding from the 523:The classic symptom of subarachnoid hemorrhage is 4619: 4617: 3136: 2285:Oxford Handbook of Clinical Medicine, 7th edition 1637:, is a serious complication of SAH. It can cause 1386:, and prevention and treatment of complications. 941:cause of SAH with this approach is less than 1%. 7453: 5207: 4998:Nature Clinical Practice Cardiovascular Medicine 3463: 3275:Fei Liu Y, Qiu HC, Jiang WJ (18 February 2016). 3265: 2787: 2409:"Norman Dott's contribution to aneurysm surgery" 1134:Moderate to severe headache; neck stiffness; no 6202: 5148:Journal of Cerebral Blood Flow & Metabolism 4877: 4875: 4873: 4319: 4317: 3602: 3274: 2914: 2406: 649:(irregularities in the heart rate and rhythm), 6149: 6147: 6145: 6143: 6141: 4614: 4275: 4273: 4054: 3926: 3705: 3703: 3355: 3353: 3351: 3307: 2659:Oxford Handbook of Acute Medicine, 2nd edition 2354: 2352: 2350: 2348: 2346: 2344: 2342: 2340: 2338: 2336: 2334: 2332: 2330: 2328: 2326: 2324: 1980:, and is the most common cause of the latter. 1449:may be administered to help relieve distress. 1445:is usually inserted to monitor fluid balance. 844:-based disinfectant, leaving brown coloration. 7211: 6757: 6242: 6240: 5760: 5758: 5756: 4509: 4027:The Canadian Journal of Neurological Sciences 3986:American Association of Neurological Surgeons 2661:. Oxford University Press. pp. 466–470. 2656: 2322: 2320: 2318: 2316: 2314: 2312: 2310: 2308: 2306: 2304: 1878:. Perimesencephalic SAH (bleeding around the 1123:or minimal headache and slight neck stiffness 594:inability to lift the eyelid on the same side 391:. Risk factors for spontaneous cases include 6340:Proceedings of the Royal Society of Medicine 5956: 5921: 5799: 5710: 5667: 5624: 5448:: CS1 maint: multiple names: authors list ( 5393:: CS1 maint: multiple names: authors list ( 5329:: CS1 maint: multiple names: authors list ( 5190:: CS1 maint: multiple names: authors list ( 4981:: CS1 maint: multiple names: authors list ( 4870: 4567: 4565: 4323: 4314: 4279: 3863:: CS1 maint: multiple names: authors list ( 3758: 2762: 2178: 2103:, was the first to introduce clips in 1938. 1468:, blood, and blood byproducts that increase 1359:Autosomal dominant polycystic kidney disease 800:(CSF) causes vasoconstriction by increasing 645:concentrations of adrenaline also may cause 16:Bleeding into the brain's subarachnoid space 6138: 5876: 5874: 5872: 5870: 5868: 5716: 4995: 4888:The Cochrane Database of Systematic Reviews 4716:The Cochrane Database of Systematic Reviews 4661: 4659: 4657: 4655: 4270: 3801: 3700: 3554: 3552: 3393: 3391: 3348: 3078: 3076: 3074: 3072: 2601:Journal of the Belgian Society of Radiology 2557:"Subarachnoid Hemorrhage: Beyond Aneurysms" 2181:Emergency Medicine Clinics of North America 1343: 616:that leads to activation of the descending 395:, smoking, family history, alcoholism, and 7218: 7204: 6764: 6750: 6306: 6287: 6249:"Risk factors for subarachnoid hemorrhage" 6237: 5753: 5543: 5541: 3761:Current Neurology and Neuroscience Reports 3598: 3596: 3132: 3130: 3128: 3126: 3124: 3122: 3120: 2688: 2652: 2650: 2648: 2646: 2644: 2642: 2407:Todd NV, Howie JE, Miller JD (June 1990). 2301: 387:or spontaneously, usually from a ruptured 48: 6443: 6359: 6264: 6220: 6179: 6121: 6080: 6023: 5939: 5898: 5823: 5782: 5521: 5480: 5425: 5408:Zussman B, Weiner GM, Ducruet A. (2017). 5362: 5159: 5127:CS1 maint: multiple names: authors list ( 5038: 4907: 4853: 4776: 4735: 4597: 4562: 4545: 4535: 4510:Tang C, Zhang TS, Zhou LF (9 June 2014). 4420: 4376: 4297: 4253: 4204: 4048: 4039: 3993: 3969: 3895: 3727: 3683: 3576: 3524: 3459: 3457: 3455: 3453: 3451: 3449: 3447: 3445: 3443: 3423: 3292: 3197: 3100: 2848: 2805: 2739: 2622: 2612: 2530: 2432: 2252: 2222: 2220: 2218: 2216: 2214: 2212: 2210: 2174: 2172: 2170: 2168: 2166: 2164: 2162: 2160: 2158: 2156: 2154: 2152: 2150: 2148: 2146: 2144: 1607:International Subarachnoid Aneurysm Trial 745:), disorders of the blood vessels in the 323:45% risk of death at 30 days (aneurysmal) 6727:, and does not reflect subsequent edits. 6710: 5865: 5851:. United States: Churchill Livingstone. 5847:Lindsay KW, Bone I, Callander R (1993). 5203: 5201: 5076:Early Brain Injury or Cerebral Vasospasm 4652: 4398: 4396: 4221: 4180: 4108: 3963: 3549: 3388: 3069: 3044: 2707: 2689:Warrell DA, Cox TM, et al. (2003). 2519:AJNR. American Journal of Neuroradiology 2465:AJNR. American Journal of Neuroradiology 2458: 2454: 2452: 2287:. Oxford University Press. p. 841. 2278: 2276: 2274: 2272: 2142: 2140: 2138: 2136: 2134: 2132: 2130: 2128: 2126: 2124: 1987: 1920: 1582:, and often other health professionals. 1483: 1479: 1453:drugs should be given to awake persons. 1010: 948: 831: 690: 6336:"Spontaneous Sub-arachnoid Haemorrhage" 6333: 5538: 4402: 4102: 3593: 3117: 3065:from the original on 10 September 2017. 2995: 2684: 2682: 2680: 2678: 2639: 2594: 1734:Some older studies have suggested that 1676:). The released clotting factors like; 1522:, depressed level of consciousness, or 7454: 6196: 5849:Neurology and Neurosurgery Illustrated 4348:from the original on 20 December 2010. 4324:White PM, Wardlaw JM (December 2003). 4145: 3638: 3440: 3222: 2483:from the original on 14 November 2005. 2402: 2400: 2398: 2207: 1826: 1768: 1554:in the groin and advanced through the 718:—a weakness in the wall of one of the 539:, decreased level of consciousness or 7199: 6745: 5198: 4571: 4393: 2449: 2269: 2121: 1916: 1870:on the eighth day of admission. 1491:showing a partially coiled aneurysm ( 518: 7016:Partial anterior circulation infarct 4010: 2675: 1956:(deficiencies in one or more of the 1807:People have often been treated with 987:The CSF sample is also examined for 743:cerebral arteriovenous malformations 376:, weakness, numbness, and sometimes 5210:The New England Journal of Medicine 4409:The New England Journal of Medicine 4326:"Unruptured intracranial aneurysms" 3655:from the original on 14 March 2012. 3639:Thomas L, et al. (July 2009). 3466:The New England Journal of Medicine 2756: 2395: 1518:People whose CT scan shows a large 921:(injecting radiocontrast through a 763:(usually in children) and, rarely, 730:also appears to increase the risk. 606:cerebral arteriovenous malformation 296:radiologically guided interventions 13: 7011:Total anterior circulation infarct 6812:Posterior cerebral artery syndrome 6697: 5977:10.1212/01.wnl.0000267640.03300.6b 5941:10.1161/01.STR.0000260093.49693.7a 5922:Greebe P, Rinkel GJ (April 2007). 5900:10.1161/01.STR.0000190838.02954.e8 5825:10.1161/01.STR.0000141936.36596.1e 5688:10.1097/01.CCM.0000198331.45998.85 4855:10.1161/01.STR.0000073841.88563.E9 2929:10.1097/01.ccx.0000216571.80944.65 944: 782: 777:Dissection of the vertebral artery 14: 7498: 6802:Anterior cerebral artery syndrome 6534: 5078:. Vol. 110. pp. 15–21. 4485:AANN Clinical Practice Guidelines 4280:Ogilvy CS, Carter BS (May 1998). 3685:10.1016/j.annemergmed.2014.01.023 3578:10.1016/j.annemergmed.2019.07.009 2807:10.1161/CIRCULATIONAHA.105.558239 2562:American Journal of Roentgenology 2493: 1932:Neurocognitive symptoms, such as 1084: 995:fluid. This can be determined by 7462:Central nervous system disorders 7318:Chronic traumatic encephalopathy 7185:Cerebral venous sinus thrombosis 6709: 5563:10.1097/00006123-198209000-00001 5053:10.1016/j.pharmthera.2004.10.002 4941:Journal of Neuroscience Research 4590:10.1097/00000658-193805000-00003 4378:10.1111/j.1523-1755.2004.00572.x 4299:10.1097/00006123-199805000-00001 4292:(5): 959–68, discussion 968–70. 4166:10.1097/00006123-198001000-00001 3618:10.1111/j.1553-2712.2010.00694.x 3314:Journal of Neuroscience Research 2973:10.1097/00006123-200202000-00006 2597:"Pseudo-subarachnoid Hemorrhage" 1814:. This is controversial and not 1570:coils are deployed that cause a 899:, of the brain. This has a high 858:cerebral venous sinus thrombosis 490:cerebral venous sinus thrombosis 430:, is frequently used to prevent 370:decreased level of consciousness 282:cerebral venous sinus thrombosis 179:decreased level of consciousness 73: 7353:Anterior spinal artery syndrome 7225: 6963:Anterior spinal artery syndrome 6807:Middle cerebral artery syndrome 6487: 6460: 6411: 6376: 6327: 6300: 6281: 6097: 6048: 5999: 5915: 5840: 5577: 5497: 5456: 5401: 5337: 5279: 5236: 5135: 5067: 5041:Pharmacology & Therapeutics 5032: 4989: 4932: 4829: 4793: 4752: 4703: 4503: 4473: 4437: 4352: 4055:Rosen DS, Macdonald RL (2005). 3920: 3871: 3822: 3795: 3752: 3716:Annals of Clinical Biochemistry 3659: 3632: 3500: 3301: 3173: 3038: 2951: 2908: 2865: 2822: 2781: 2588: 1983: 1972:). SAH is also associated with 1958:hypothalamic–pituitary hormones 1369:only if they have a reasonable 1262:to gauge severity of symptoms. 1045:Also one of the characteristic 820:. Besides, the disturbances of 383:SAH may occur as a result of a 4900:10.1002/14651858.CD000277.pub3 4728:10.1002/14651858.CD003085.pub3 2967:(2): 261–7, discussion 267–9. 2829:O'Leary R, McKinlay J (2011). 2765:Oxford Handbook of Anaesthesia 2547: 2506: 2487: 1866:of the brain) and presence of 1472:and may increase the risk for 1413:feeding being preferable over 911: 602:posterior communicating artery 366:severe headache of rapid onset 171:Severe headache of rapid onset 1: 6968:Vertebrobasilar insufficiency 6309:Quarterly Journal of Medicine 5602:10.1016/S1474-4422(03)00531-3 5257:10.1016/S1474-4422(06)70582-8 4681:10.1016/S0140-6736(05)67214-5 3843:10.1016/s0022-0736(05)80007-x 3281:Chinese Neurosurgical Journal 3237:(2): 131–40, discussion 140. 3016:10.1016/S1474-4422(06)70497-5 2831:"Neurogenic pulmonary oedema" 2763:Allman KG, Wilson IH (2006). 2373:10.1016/S0140-6736(07)60153-6 2114: 1942:posttraumatic stress disorder 1603:anterior communicating artery 699:Most cases of SAH are due to 653:(in 27 percent of cases) and 566:(pressure inside the skull). 498:leptomeningeal carcinomatosis 451:pseudosubarachnoid hemorrhage 23:Pseudosubarachnoid hemorrhage 6222:10.1161/STROKEAHA.113.001326 6025:10.1161/STROKEAHA.108.529974 5784:10.1161/STROKEAHA.107.484360 5482:10.1161/STROKEAHA.109.556332 5364:10.1161/STROKEAHA.119.027396 4778:10.1161/STROKEAHA.106.466987 4537:10.1371/journal.pone.0099536 3878:SCHER AM, YOUNG AC. (1956). 3831:Journal of Electrocardiology 3804:Journal of Electrocardiology 3672:Annals of Emergency Medicine 3565:Annals of Emergency Medicine 3526:10.1161/STROKEAHA.115.011386 3199:10.1161/strokeaha.116.015674 2657:Ramrakha P, Moore K (2007). 1970:follicle-stimulating hormone 1821: 1713:Food and Drug Administration 1657:is suggestive of vasospasm. 1625: 1376: 1158:; minimal neurologic deficit 827: 769:problems with blood clotting 749:, and bleeding into various 651:electrocardiographic changes 639:systemic vascular resistance 7: 7256:Intraventricular hemorrhage 7251:Intraparenchymal hemorrhage 5222:10.1056/NEJM198303173081103 5084:10.1007/978-3-7091-0353-1_3 4422:10.1056/NEJM199812103392401 3645:Emergency Medicine Practice 2691:Oxford Textbook of Medicine 2233:Academic Emergency Medicine 2031:hormone replacement therapy 1892:persistent vegetative state 1595:randomized controlled trial 1503:Efforts to keep a person's 1274:Focal neurological deficit 1253:intraventricular hemorrhage 1173:and vegetative disturbances 925:to the brain arteries) and 554:of a pupil and loss of the 484:contrast material into the 473:. It may also occur due to 10: 7503: 7472:Disorders causing seizures 6937:Cerebellar stroke syndrome 6870:Lateral medullary syndrome 6397:10.3171/jns.1972.37.6.0678 6352:10.1177/003591572401700918 6321:10.1093/qjmed/os-118.69.93 4638:10.3171/jns.1991.75.1.0008 4123:10.3171/jns.1968.28.1.0014 4072:Neurocritical Care Society 3970:Wang AC, Heros RC (2016). 2595:Coulier B (1 March 2018). 2051: 1905:that also plays a role in 1839:; a previous diagnosis of 1729:external ventricular drain 1611:activities of daily living 1493:indicated by yellow arrows 1458:external ventricular drain 1260:focal neurological deficit 1233:More than 1 mm thick 1232: 1225:Less than 1 mm thick 1154: 991:—the yellow appearance of 967:(CSF) is removed from the 906:magnetic resonance imaging 891:The modality of choice is 886: 812:and reducing the level of 618:sympathetic nervous system 475:intrathecally administered 20: 7429:Injury of accessory nerve 7397: 7343: 7233: 7172: 7162:Charcot–Bouchard aneurysm 7147: 7127: 7109: 7091: 7065: 7056: 7026: 7006:Transient ischemic attack 6983: 6973:Subclavian steal syndrome 6945: 6927: 6865:Medial medullary syndrome 6855:Brainstem stroke syndrome 6845: 6792: 6783: 6639: 6542: 6290:Edinburgh Medical Journal 5731:10.1007/s12028-007-0061-5 4815:10.1148/radiol.2431060006 4330:Journal of Neuroradiology 4041:10.1017/S0317167100000305 3773:10.1007/s11910-009-0071-0 3294:10.1186/s41016-016-0023-x 3243:10.1007/s10143-008-0124-x 2193:10.1016/j.emc.2016.06.011 1812:antiepileptic medications 1613:was reduced (7.4 percent 1497:posterior cerebral artery 1209:Appearance of hemorrhage 686: 668:into the air spaces, the 364:. Symptoms may include a 327: 317: 301: 287: 267: 251: 227: 213: 205: 184: 164: 148: 65: 56: 47: 39: 34: 7467:Cerebrovascular diseases 7303:Post-concussion syndrome 7044:Transient global amnesia 6891:Lateral pontine syndrome 6827:Dejerine–Roussy syndrome 6773:Cerebrovascular diseases 6436:10.1136/bmj.298.6674.636 6172:10.1136/jnnp.2007.117655 6123:10.1001/jama.298.12.1429 5510:Cerebrovascular Diseases 5301:10.3171/2019.9.JNS191366 5161:10.1038/sj.jcbfm.9600471 3151:10.1179/016164106X115053 3102:10.1161/01.STR.24.9.1403 2850:10.1093/bjaceaccp/mkr006 2732:10.1136/jnnp.2003.016816 2459:Strother CM (May 2001). 2009:, such as a decrease in 1701:calcium channel blockers 1599:anterior cerebral artery 1344:Screening and prevention 1267: 1205: 1105: 1075:ventricular fibrillation 862:Intracerebral hemorrhage 822:autonomic nervous system 775:can also result in SAH. 625:; mediated by increased 502:intracranial hypotension 453:, an apparent increased 43:Subarachnoid haemorrhage 7477:Intensive care medicine 7412:Peripheral nerve injury 7378:Posterior cord syndrome 7335:Penetrating head injury 7276:Subarachnoid hemorrhage 7243:Intracranial hemorrhage 7135:Intracranial hemorrhage 6953:Carotid artery stenosis 6882:Medial pontine syndrome 6385:Journal of Neurosurgery 6266:10.1161/01.STR.16.3.377 5633:Journal of Neurosurgery 5289:Journal of Neurosurgery 4626:Journal of Neurosurgery 4459:10.1148/radiol.10091982 4246:10.1136/jnnp.51.11.1457 4111:Journal of Neurosurgery 3995:10.3171/2015.3.JNS15336 3977:Journal of Neurosurgery 3729:10.1258/acb.2008.007257 3374:10.1161/01.STR.27.3.544 1896:post traumatic epilepsy 1750:(high blood pressure), 1694:reactive oxygen species 1615:absolute risk reduction 1505:systolic blood pressure 1395:mechanically ventilated 1081:in unmanaged patients. 709:intracerebral contusion 480:, leakage of high-dose 428:calcium channel blocker 410:Treatment is by prompt 338:Subarachnoid hemorrhage 35:Subarachnoid hemorrhage 7434:Brachial plexus injury 7424:Wallerian degeneration 7358:Brown-Séquard syndrome 7308:Second-impact syndrome 7235:Traumatic brain injury 6705: 6685:Listen to this article 6346:(Neurol Sect): 39–52. 5676:Critical Care Medicine 5645:10.3171/JNS-07/08/0253 3897:10.1161/01.res.4.4.461 3425:10.1001/jama.291.7.866 1993: 1929: 1860:intracerebral hematoma 1816:based on good evidence 1798:cardiac decompensation 1782:extraventricular drain 1746:to achieve a state of 1655:centimeters per second 1653:of more than 120 1587:middle cerebral artery 1558:to the arteries (both 1546:. Clipping requires a 1528:transfemoral angiogram 1524:focal neurologic signs 1500: 1016: 1006: 957: 845: 696: 568:Intraocular hemorrhage 562:as a result of rising 556:pupillary light reflex 506:cerebellar infarctions 488:, or in patients with 418:. Medications such as 352:—the area between the 269:Differential diagnosis 7368:Central cord syndrome 7363:Cauda equina syndrome 7325:Diffuse axonal injury 7157:Intracranial aneurysm 6946:Extracranial arteries 6704: 6073:10.1136/jnnp.72.6.772 5590:The Lancet. Neurology 5427:10.1093/neuros/nyx260 5245:The Lancet. Neurology 5010:10.1038/ncpcardio0046 4572:Dandy WE (May 1938). 4206:10.1161/hs0901.095677 3139:Neurological Research 3004:The Lancet. Neurology 2425:10.1136/jnnp.53.6.455 1991: 1978:cerebral salt wasting 1924: 1837:systolic hypertension 1790:electrolyte imbalance 1487: 1480:Preventing rebleeding 1470:intracranial pressure 1431:compression stockings 1337:classification scheme 1014: 952: 835: 694: 637:leading to increased 574:, which envelops the 564:intracranial pressure 331:1 per 10,000 per year 7313:Dementia pugilistica 7093:Cerebral/Intra-axial 7039:Binswanger's disease 6736:More spoken articles 6496:Acta Neurochirurgica 4365:Kidney International 3884:Circulation Research 3478:10.1056/NEJMra052732 3231:Neurosurgical Review 1674:Virchow-Robin spaces 1650:transcranial doppler 1427:Deep vein thrombosis 1367:preventive treatment 1186:decerebrate rigidity 1171:decerebrate rigidity 1032:cardiac dysrhythmias 1020:Electrocardiographic 919:cerebral angiography 877:physical examination 525:thunderclap headache 444:endovascular coiling 416:endovascular coiling 7330:Abusive head trauma 7293:Cerebral laceration 7180:Cerebral vasculitis 7058:Haemorrhagic stroke 6996:Cerebral infarction 6334:Symonds CP (1924). 4528:2014PLoSO...999536T 4491:on 29 December 2013 4080:10.1385/NCC:2:2:110 3941:10.1385/NCC:2:2:110 3045:Parrillo J (2013). 2917:Curr Opin Crit Care 2886:10.1385/NCC:5:3:243 2574:10.2214/AJR.12.9749 2027:caucasian ethnicity 2023:alcohol consumption 1966:luteinizing hormone 1907:Alzheimer's disease 1827:Short-term outcomes 1769:Other complications 1670:perivascular spaces 1466:cerebrospinal fluid 1437:compression of the 1407:intensive care unit 1109:Signs and symptoms 965:cerebrospinal fluid 895:(CT scan), without 893:computed tomography 798:cerebrospinal fluid 647:cardiac arrhythmias 582:. This is known as 486:subarachnoid spaces 393:high blood pressure 234:High blood pressure 7345:Spinal cord injury 7288:Cerebral contusion 7119:Duret haemorrhages 6706: 6640:External resources 6508:10.1007/BF01406044 5719:Neurocritical Care 4064:Neurocritical Care 3929:Neurocritical Care 3308:Kolias AG, Sen J, 2245:10.1111/acem.12984 2074:Charles P. Symonds 2068:. In 1924, London 2043:sexual intercourse 1994: 1930: 1917:Long-term outcomes 1778:lateral ventricles 1744:intravenous fluids 1572:blood clot to form 1564:vertebral arteries 1501: 1474:cerebral vasospasm 1429:is prevented with 1397:. Blood pressure, 1329:Present or absent 1318:Present or absent 1091:Glasgow Coma Scale 1017: 969:subarachnoid space 958: 846: 773:pituitary apoplexy 761:sickle cell anemia 697: 519:Signs and symptoms 513:subdural hematomas 354:arachnoid membrane 350:subarachnoid space 196:cerebral vasospasm 7447: 7446: 7439:Traumatic neuroma 7399:Peripheral nerves 7271:Epidural hematoma 7266:Subdural hematoma 7193: 7192: 7143: 7142: 7052: 7051: 6917:Claude's syndrome 6912:Benedikt syndrome 6702: 6680: 6679: 5858:978-0-443-04345-1 5523:10.1159/000446251 5154:(10): 1692–1701. 5093:978-3-7091-0352-4 4953:10.1002/jnr.21823 4578:Annals of Surgery 3678:(3): 256–264.e5. 3406:(February 2004). 3326:10.1002/jnr.21823 2774:978-0-19-856609-0 2700:978-0-19-857013-4 2668:978-0-19-852072-6 2614:10.5334/jbsr.1509 2294:978-0-19-856837-7 2035:diabetes mellitus 1858:, development of 1721:magnesium sulfate 1536:cerebral aneurysm 1462:aseptic technique 1333: 1332: 1249: 1248: 1198: 1197: 997:spectrophotometry 977:hypodermic needle 956:versus normal CSF 875:and performing a 716:cerebral aneurysm 478:contrast material 389:cerebral aneurysm 335: 334: 253:Diagnostic method 222:cerebral aneurysm 192:cerebral ischemia 29:Medical condition 7494: 7283:Brain herniation 7220: 7213: 7206: 7197: 7196: 7101:Intraventricular 7063: 7062: 6907:Weber's syndrome 6832:Watershed stroke 6822:Moyamoya disease 6790: 6789: 6785:Ischaemic stroke 6766: 6759: 6752: 6743: 6742: 6726: 6724: 6713: 6712: 6703: 6693: 6691: 6686: 6540: 6539: 6528: 6527: 6491: 6485: 6484: 6464: 6458: 6457: 6447: 6430:(6674): 636–42. 6415: 6409: 6408: 6380: 6374: 6373: 6363: 6331: 6325: 6324: 6304: 6298: 6297: 6285: 6279: 6278: 6268: 6244: 6235: 6234: 6224: 6200: 6194: 6193: 6183: 6151: 6136: 6135: 6125: 6101: 6095: 6094: 6084: 6052: 6046: 6045: 6027: 6003: 5997: 5996: 5960: 5954: 5953: 5943: 5919: 5913: 5912: 5902: 5878: 5863: 5862: 5844: 5838: 5837: 5827: 5803: 5797: 5796: 5786: 5762: 5751: 5750: 5714: 5708: 5707: 5671: 5665: 5664: 5628: 5622: 5621: 5581: 5575: 5574: 5545: 5536: 5535: 5525: 5501: 5495: 5494: 5484: 5460: 5454: 5453: 5447: 5439: 5429: 5405: 5399: 5398: 5392: 5384: 5366: 5357:(4): 1142–1149. 5341: 5335: 5334: 5328: 5320: 5283: 5277: 5276: 5240: 5234: 5233: 5205: 5196: 5195: 5189: 5181: 5163: 5139: 5133: 5132: 5125: 5119: 5115: 5113: 5105: 5071: 5065: 5064: 5036: 5030: 5029: 4993: 4987: 4986: 4980: 4972: 4936: 4930: 4929: 4911: 4879: 4868: 4867: 4857: 4833: 4827: 4826: 4797: 4791: 4790: 4780: 4756: 4750: 4749: 4739: 4707: 4701: 4700: 4675:(9488): 809–17. 4663: 4650: 4649: 4621: 4612: 4611: 4601: 4569: 4560: 4559: 4549: 4539: 4507: 4501: 4500: 4498: 4496: 4477: 4471: 4470: 4441: 4435: 4434: 4424: 4400: 4391: 4390: 4380: 4356: 4350: 4349: 4321: 4312: 4311: 4301: 4277: 4268: 4267: 4257: 4225: 4219: 4218: 4208: 4184: 4178: 4177: 4149: 4143: 4142: 4106: 4100: 4099: 4061: 4052: 4046: 4045: 4043: 4023: 4014: 4008: 4007: 3997: 3967: 3961: 3960: 3924: 3918: 3917: 3899: 3875: 3869: 3868: 3862: 3854: 3826: 3820: 3819: 3799: 3793: 3792: 3756: 3750: 3749: 3731: 3722:(Pt 3): 238–44. 3707: 3698: 3697: 3687: 3663: 3657: 3656: 3636: 3630: 3629: 3600: 3591: 3590: 3580: 3556: 3547: 3546: 3528: 3504: 3498: 3497: 3461: 3438: 3437: 3427: 3395: 3386: 3385: 3357: 3346: 3345: 3305: 3299: 3298: 3296: 3272: 3263: 3262: 3226: 3220: 3219: 3201: 3192:(5): 1210–1217. 3177: 3171: 3170: 3134: 3115: 3114: 3104: 3080: 3067: 3066: 3042: 3036: 3035: 2999: 2993: 2992: 2955: 2949: 2948: 2912: 2906: 2905: 2869: 2863: 2862: 2852: 2826: 2820: 2819: 2809: 2785: 2779: 2778: 2760: 2754: 2753: 2743: 2711: 2705: 2704: 2686: 2673: 2672: 2654: 2637: 2636: 2626: 2616: 2592: 2586: 2585: 2559: 2551: 2545: 2544: 2534: 2510: 2504: 2503: 2491: 2485: 2484: 2456: 2447: 2446: 2436: 2404: 2393: 2392: 2367:(9558): 306–18. 2356: 2299: 2298: 2280: 2267: 2266: 2256: 2224: 2205: 2204: 2176: 1903:apolipoprotein E 1580:neuroradiologist 1560:carotid arteries 1443:bladder catheter 1411:nasogastric tube 1403:respiratory rate 1335:A comprehensive 1265: 1264: 1203: 1202: 1103: 1102: 866:tension headache 724:circle of Willis 635:vasoconstriction 590:Oculomotor nerve 572:hyaloid membrane 560:brain herniation 471:cerebral hypoxia 360:surrounding the 140: 139: 136: 135: 132: 129: 126: 123: 120: 117: 113: 112: 109: 106: 103: 100: 97: 94: 91: 88: 85: 82: 79: 52: 32: 31: 7502: 7501: 7497: 7496: 7495: 7493: 7492: 7491: 7452: 7451: 7448: 7443: 7393: 7339: 7229: 7224: 7194: 7189: 7168: 7139: 7123: 7105: 7087: 7048: 7022: 6979: 6941: 6923: 6841: 6817:Amaurosis fugax 6779: 6770: 6740: 6739: 6728: 6722: 6720: 6717:This audio file 6714: 6707: 6698: 6695: 6689: 6688: 6684: 6681: 6676: 6675: 6635: 6634: 6551: 6537: 6532: 6531: 6492: 6488: 6465: 6461: 6416: 6412: 6381: 6377: 6332: 6328: 6305: 6301: 6286: 6282: 6245: 6238: 6201: 6197: 6166:(12): 1365–72. 6152: 6139: 6116:(12): 1429–38. 6102: 6098: 6053: 6049: 6004: 6000: 5961: 5957: 5920: 5916: 5893:(12): 2773–80. 5879: 5866: 5859: 5845: 5841: 5804: 5800: 5763: 5754: 5715: 5711: 5672: 5668: 5629: 5625: 5582: 5578: 5546: 5539: 5516:(3–4): 263–71. 5502: 5498: 5461: 5457: 5441: 5440: 5406: 5402: 5386: 5385: 5342: 5338: 5322: 5321: 5284: 5280: 5251:(12): 1029–32. 5241: 5237: 5206: 5199: 5183: 5182: 5140: 5136: 5126: 5117: 5116: 5107: 5106: 5094: 5072: 5068: 5037: 5033: 4994: 4990: 4974: 4973: 4937: 4933: 4894:(3): CD000277. 4880: 4871: 4848:(6): 1398–403. 4834: 4830: 4798: 4794: 4757: 4753: 4722:(8): CD003085. 4708: 4704: 4664: 4653: 4622: 4615: 4570: 4563: 4508: 4504: 4494: 4492: 4479: 4478: 4474: 4442: 4438: 4415:(24): 1725–33. 4401: 4394: 4357: 4353: 4322: 4315: 4278: 4271: 4226: 4222: 4185: 4181: 4150: 4146: 4107: 4103: 4059: 4053: 4049: 4021: 4015: 4011: 3968: 3964: 3925: 3921: 3876: 3872: 3856: 3855: 3827: 3823: 3800: 3796: 3757: 3753: 3708: 3701: 3664: 3660: 3637: 3633: 3601: 3594: 3557: 3550: 3505: 3501: 3462: 3441: 3396: 3389: 3358: 3349: 3306: 3302: 3273: 3266: 3227: 3223: 3178: 3174: 3135: 3118: 3081: 3070: 3059: 3043: 3039: 3000: 2996: 2956: 2952: 2913: 2909: 2870: 2866: 2827: 2823: 2786: 2782: 2775: 2761: 2757: 2712: 2708: 2701: 2687: 2676: 2669: 2655: 2640: 2593: 2589: 2552: 2548: 2511: 2507: 2492: 2488: 2457: 2450: 2405: 2396: 2357: 2302: 2295: 2281: 2270: 2239:(9): 963–1003. 2225: 2208: 2177: 2122: 2117: 2078:lumbar puncture 2054: 1986: 1954:hypopituitarism 1950:pituitary gland 1919: 1829: 1824: 1771: 1678:fibrinopeptides 1666:endothelial NOS 1628: 1617:, 23.5 percent 1482: 1447:Benzodiazepines 1433:, intermittent 1379: 1371:life expectancy 1346: 1138:deficit except 1087: 1024:QT prolongation 1009: 981:red blood cells 961:Lumbar puncture 947: 945:Lumbar puncture 914: 889: 881:medical imaging 873:medical history 838:lumbar puncture 830: 790:tyrosine kinase 788:stimulates the 785: 783:Pathophysiology 689: 672:, of the lung. 662:pulmonary edema 584:Terson syndrome 521: 405:lumbar puncture 262:lumbar puncture 144: 114: 76: 72: 30: 25: 17: 12: 11: 5: 7500: 7490: 7489: 7484: 7479: 7474: 7469: 7464: 7445: 7444: 7442: 7441: 7436: 7431: 7426: 7421: 7420: 7419: 7417:classification 7414: 7403: 7401: 7395: 7394: 7392: 7391: 7390:(Quadriplegia) 7385: 7380: 7375: 7370: 7365: 7360: 7355: 7349: 7347: 7341: 7340: 7338: 7337: 7332: 7327: 7322: 7321: 7320: 7315: 7310: 7305: 7295: 7290: 7285: 7280: 7279: 7278: 7273: 7268: 7260: 7259: 7258: 7253: 7245: 7239: 7237: 7231: 7230: 7223: 7222: 7215: 7208: 7200: 7191: 7190: 7188: 7187: 7182: 7176: 7174: 7170: 7169: 7167: 7166: 7165: 7164: 7153: 7151: 7145: 7144: 7141: 7140: 7138: 7137: 7131: 7129: 7125: 7124: 7122: 7121: 7115: 7113: 7107: 7106: 7104: 7103: 7097: 7095: 7089: 7088: 7086: 7085: 7080: 7075: 7069: 7067: 7060: 7054: 7053: 7050: 7049: 7047: 7046: 7041: 7036: 7030: 7028: 7024: 7023: 7021: 7020: 7019: 7018: 7013: 7008: 7001:Classification 6998: 6993: 6991:Brain ischemia 6987: 6985: 6984:Classification 6981: 6980: 6978: 6977: 6976: 6975: 6965: 6960: 6955: 6949: 6947: 6943: 6942: 6940: 6939: 6933: 6931: 6925: 6924: 6922: 6921: 6920: 6919: 6914: 6909: 6899: 6898: 6897: 6895:Millard-Gubler 6888: 6874: 6873: 6872: 6867: 6857: 6851: 6849: 6843: 6842: 6840: 6839: 6837:Lacunar stroke 6834: 6829: 6824: 6819: 6814: 6809: 6804: 6798: 6796: 6787: 6781: 6780: 6769: 6768: 6761: 6754: 6746: 6729: 6715: 6708: 6696: 6683: 6682: 6678: 6677: 6674: 6673: 6656: 6644: 6643: 6641: 6637: 6636: 6633: 6632: 6621: 6610: 6599: 6576: 6552: 6547: 6546: 6544: 6543:Classification 6536: 6535:External links 6533: 6530: 6529: 6502:(1–2): 65–79. 6486: 6459: 6410: 6375: 6326: 6315:(69): 93–122. 6299: 6280: 6236: 6195: 6137: 6096: 6047: 6018:(6): e424-30. 5998: 5955: 5914: 5864: 5857: 5839: 5798: 5777:(8): 2315–21. 5752: 5709: 5666: 5623: 5596:(10): 614–21. 5576: 5537: 5496: 5455: 5400: 5336: 5278: 5235: 5216:(11): 619–24. 5197: 5134: 5118:|journal= 5092: 5066: 5031: 5004:(2): 110–116. 4988: 4931: 4869: 4828: 4792: 4771:(5): 1538–44. 4751: 4702: 4651: 4613: 4561: 4502: 4472: 4436: 4392: 4351: 4313: 4269: 4220: 4199:(9): 2012–20. 4179: 4144: 4101: 4047: 4034:(3): 230–246. 4009: 3962: 3919: 3890:(4): 461–469. 3870: 3821: 3794: 3751: 3699: 3658: 3631: 3606:Acad Emerg Med 3592: 3571:(4): e41–e74. 3548: 3499: 3439: 3387: 3347: 3300: 3264: 3221: 3172: 3116: 3068: 3057: 3037: 2994: 2950: 2907: 2880:(3): 243–249. 2874:Neurocrit Care 2864: 2821: 2800:(21): 3314–9. 2780: 2773: 2755: 2706: 2699: 2674: 2667: 2638: 2587: 2546: 2525:(2): 254–256. 2505: 2486: 2448: 2394: 2300: 2293: 2268: 2206: 2187:(4): 901–916. 2119: 2118: 2116: 2113: 2089:Harvey Cushing 2084:in diagnosis. 2066:Byrom Bramwell 2053: 2050: 1985: 1982: 1962:growth hormone 1918: 1915: 1828: 1825: 1823: 1820: 1770: 1767: 1682:thromboxane A2 1627: 1624: 1591:basilar artery 1552:femoral artery 1481: 1478: 1378: 1375: 1353:cost-effective 1345: 1342: 1331: 1330: 1327: 1324: 1320: 1319: 1316: 1313: 1309: 1308: 1305: 1302: 1298: 1297: 1294: 1291: 1287: 1286: 1283: 1280: 1276: 1275: 1272: 1269: 1247: 1246: 1239: 1235: 1234: 1231: 1227: 1226: 1223: 1219: 1218: 1215: 1211: 1210: 1207: 1196: 1195: 1192: 1182: 1178: 1177: 1174: 1167: 1163: 1162: 1159: 1153: 1149: 1148: 1145: 1132: 1128: 1127: 1124: 1118: 1114: 1113: 1110: 1107: 1086: 1085:Classification 1083: 1079:cardiac arrest 1071:catecholamines 1067:depolarization 1063:repolarization 1038:that mimics a 1008: 1005: 946: 943: 927:CT angiography 913: 910: 888: 885: 829: 826: 794:Oxyhaemoglobin 784: 781: 705:skull fracture 688: 685: 655:cardiac arrest 633:and increased 623:blood pressure 520: 517: 467:cerebral edema 463:basal cisterns 333: 332: 329: 325: 324: 321: 315: 314: 305: 299: 298: 289: 285: 284: 271: 265: 264: 255: 249: 248: 231: 225: 224: 215: 211: 210: 207: 203: 202: 188: 182: 181: 168: 162: 161: 152: 146: 145: 143: 142: 69: 67: 63: 62: 61:to either side 54: 53: 45: 44: 41: 37: 36: 28: 15: 9: 6: 4: 3: 2: 7499: 7488: 7485: 7483: 7480: 7478: 7475: 7473: 7470: 7468: 7465: 7463: 7460: 7459: 7457: 7450: 7440: 7437: 7435: 7432: 7430: 7427: 7425: 7422: 7418: 7415: 7413: 7410: 7409: 7408: 7405: 7404: 7402: 7400: 7396: 7389: 7386: 7384: 7381: 7379: 7376: 7374: 7371: 7369: 7366: 7364: 7361: 7359: 7356: 7354: 7351: 7350: 7348: 7346: 7342: 7336: 7333: 7331: 7328: 7326: 7323: 7319: 7316: 7314: 7311: 7309: 7306: 7304: 7301: 7300: 7299: 7296: 7294: 7291: 7289: 7286: 7284: 7281: 7277: 7274: 7272: 7269: 7267: 7264: 7263: 7261: 7257: 7254: 7252: 7249: 7248: 7246: 7244: 7241: 7240: 7238: 7236: 7232: 7228: 7221: 7216: 7214: 7209: 7207: 7202: 7201: 7198: 7186: 7183: 7181: 7178: 7177: 7175: 7171: 7163: 7160: 7159: 7158: 7155: 7154: 7152: 7150: 7146: 7136: 7133: 7132: 7130: 7126: 7120: 7117: 7116: 7114: 7112: 7108: 7102: 7099: 7098: 7096: 7094: 7090: 7084: 7081: 7079: 7076: 7074: 7071: 7070: 7068: 7064: 7061: 7059: 7055: 7045: 7042: 7040: 7037: 7035: 7032: 7031: 7029: 7025: 7017: 7014: 7012: 7009: 7007: 7004: 7003: 7002: 6999: 6997: 6994: 6992: 6989: 6988: 6986: 6982: 6974: 6971: 6970: 6969: 6966: 6964: 6961: 6959: 6956: 6954: 6951: 6950: 6948: 6944: 6938: 6935: 6934: 6932: 6930: 6926: 6918: 6915: 6913: 6910: 6908: 6905: 6904: 6903: 6900: 6896: 6892: 6889: 6887: 6883: 6880: 6879: 6878: 6875: 6871: 6868: 6866: 6863: 6862: 6861: 6858: 6856: 6853: 6852: 6850: 6848: 6844: 6838: 6835: 6833: 6830: 6828: 6825: 6823: 6820: 6818: 6815: 6813: 6810: 6808: 6805: 6803: 6800: 6799: 6797: 6795: 6791: 6788: 6786: 6782: 6778: 6774: 6767: 6762: 6760: 6755: 6753: 6748: 6747: 6744: 6737: 6733: 6718: 6672: 6669: 6666: 6662: 6661: 6657: 6655: 6651: 6650: 6646: 6645: 6642: 6638: 6631: 6627: 6626: 6622: 6620: 6616: 6615: 6611: 6609: 6605: 6604: 6600: 6598: 6594: 6590: 6586: 6585: 6581: 6577: 6575: 6571: 6567: 6563: 6562: 6558: 6554: 6553: 6550: 6545: 6541: 6525: 6521: 6517: 6513: 6509: 6505: 6501: 6497: 6490: 6482: 6478: 6474: 6470: 6463: 6455: 6451: 6446: 6441: 6437: 6433: 6429: 6425: 6421: 6414: 6406: 6402: 6398: 6394: 6391:(6): 678–86. 6390: 6386: 6379: 6371: 6367: 6362: 6357: 6353: 6349: 6345: 6341: 6337: 6330: 6322: 6318: 6314: 6310: 6303: 6295: 6291: 6284: 6276: 6272: 6267: 6262: 6259:(3): 377–85. 6258: 6254: 6250: 6243: 6241: 6232: 6228: 6223: 6218: 6215:(7): 1833–9. 6214: 6210: 6206: 6199: 6191: 6187: 6182: 6177: 6173: 6169: 6165: 6161: 6157: 6150: 6148: 6146: 6144: 6142: 6133: 6129: 6124: 6119: 6115: 6111: 6107: 6100: 6092: 6088: 6083: 6078: 6074: 6070: 6067:(6): 772–81. 6066: 6062: 6058: 6051: 6043: 6039: 6035: 6031: 6026: 6021: 6017: 6013: 6009: 6002: 5994: 5990: 5986: 5982: 5978: 5974: 5971:(8): 766–75. 5970: 5966: 5959: 5951: 5947: 5942: 5937: 5934:(4): 1222–4. 5933: 5929: 5925: 5918: 5910: 5906: 5901: 5896: 5892: 5888: 5884: 5877: 5875: 5873: 5871: 5869: 5860: 5854: 5850: 5843: 5835: 5831: 5826: 5821: 5817: 5813: 5809: 5802: 5794: 5790: 5785: 5780: 5776: 5772: 5768: 5761: 5759: 5757: 5748: 5744: 5740: 5736: 5732: 5728: 5725:(2): 175–84. 5724: 5720: 5713: 5705: 5701: 5697: 5693: 5689: 5685: 5682:(2): 511–24. 5681: 5677: 5670: 5662: 5658: 5654: 5650: 5646: 5642: 5639:(2): 253–60. 5638: 5634: 5627: 5619: 5615: 5611: 5607: 5603: 5599: 5595: 5591: 5587: 5580: 5572: 5568: 5564: 5560: 5557:(3): 337–43. 5556: 5552: 5544: 5542: 5533: 5529: 5524: 5519: 5515: 5511: 5507: 5500: 5492: 5488: 5483: 5478: 5475:(1): e47-52. 5474: 5470: 5466: 5459: 5451: 5445: 5437: 5433: 5428: 5423: 5419: 5415: 5411: 5404: 5396: 5390: 5382: 5378: 5374: 5370: 5365: 5360: 5356: 5352: 5348: 5340: 5332: 5326: 5318: 5314: 5310: 5306: 5302: 5298: 5295:(1): 95–101. 5294: 5290: 5282: 5274: 5270: 5266: 5262: 5258: 5254: 5250: 5246: 5239: 5231: 5227: 5223: 5219: 5215: 5211: 5204: 5202: 5193: 5187: 5179: 5175: 5171: 5167: 5162: 5157: 5153: 5149: 5145: 5138: 5130: 5123: 5111: 5103: 5099: 5095: 5089: 5085: 5081: 5077: 5070: 5062: 5058: 5054: 5050: 5046: 5042: 5035: 5027: 5023: 5019: 5015: 5011: 5007: 5003: 4999: 4992: 4984: 4978: 4970: 4966: 4962: 4958: 4954: 4950: 4946: 4942: 4935: 4927: 4923: 4919: 4915: 4910: 4905: 4901: 4897: 4893: 4889: 4885: 4878: 4876: 4874: 4865: 4861: 4856: 4851: 4847: 4843: 4839: 4832: 4824: 4820: 4816: 4812: 4808: 4804: 4796: 4788: 4784: 4779: 4774: 4770: 4766: 4762: 4755: 4747: 4743: 4738: 4733: 4729: 4725: 4721: 4717: 4713: 4706: 4698: 4694: 4690: 4686: 4682: 4678: 4674: 4670: 4662: 4660: 4658: 4656: 4647: 4643: 4639: 4635: 4631: 4627: 4620: 4618: 4609: 4605: 4600: 4595: 4591: 4587: 4583: 4579: 4575: 4568: 4566: 4557: 4553: 4548: 4543: 4538: 4533: 4529: 4525: 4522:(6): e99536. 4521: 4517: 4513: 4506: 4490: 4486: 4482: 4476: 4468: 4464: 4460: 4456: 4453:(3): 887–97. 4452: 4448: 4440: 4432: 4428: 4423: 4418: 4414: 4410: 4406: 4399: 4397: 4388: 4384: 4379: 4374: 4371:(5): 1621–7. 4370: 4366: 4362: 4355: 4347: 4343: 4339: 4336:(5): 336–50. 4335: 4331: 4327: 4320: 4318: 4309: 4305: 4300: 4295: 4291: 4287: 4283: 4276: 4274: 4265: 4261: 4256: 4251: 4247: 4243: 4239: 4235: 4231: 4224: 4216: 4212: 4207: 4202: 4198: 4194: 4190: 4183: 4175: 4171: 4167: 4163: 4159: 4155: 4148: 4140: 4136: 4132: 4128: 4124: 4120: 4116: 4112: 4105: 4097: 4093: 4089: 4085: 4081: 4077: 4073: 4069: 4065: 4058: 4051: 4042: 4037: 4033: 4029: 4028: 4020: 4013: 4005: 4001: 3996: 3991: 3987: 3983: 3979: 3978: 3973: 3966: 3958: 3954: 3950: 3946: 3942: 3938: 3934: 3930: 3923: 3915: 3911: 3907: 3903: 3898: 3893: 3889: 3885: 3881: 3874: 3866: 3860: 3852: 3848: 3844: 3840: 3836: 3832: 3825: 3817: 3813: 3809: 3805: 3798: 3790: 3786: 3782: 3778: 3774: 3770: 3767:(6): 486–91. 3766: 3762: 3755: 3747: 3743: 3739: 3735: 3730: 3725: 3721: 3717: 3713: 3706: 3704: 3695: 3691: 3686: 3681: 3677: 3673: 3669: 3662: 3654: 3650: 3646: 3642: 3635: 3627: 3623: 3619: 3615: 3612:(4): 444–51. 3611: 3607: 3599: 3597: 3588: 3584: 3579: 3574: 3570: 3566: 3562: 3555: 3553: 3544: 3540: 3536: 3532: 3527: 3522: 3518: 3514: 3510: 3503: 3495: 3491: 3487: 3483: 3479: 3475: 3472:(4): 387–96. 3471: 3467: 3460: 3458: 3456: 3454: 3452: 3450: 3448: 3446: 3444: 3435: 3431: 3426: 3421: 3417: 3413: 3409: 3405: 3401: 3394: 3392: 3383: 3379: 3375: 3371: 3367: 3363: 3356: 3354: 3352: 3343: 3339: 3335: 3331: 3327: 3323: 3319: 3315: 3311: 3304: 3295: 3290: 3286: 3282: 3278: 3271: 3269: 3260: 3256: 3252: 3248: 3244: 3240: 3236: 3232: 3225: 3217: 3213: 3209: 3205: 3200: 3195: 3191: 3187: 3183: 3176: 3168: 3164: 3160: 3156: 3152: 3148: 3145:(4): 445–52. 3144: 3140: 3133: 3131: 3129: 3127: 3125: 3123: 3121: 3112: 3108: 3103: 3098: 3095:(9): 1403–9. 3094: 3090: 3086: 3079: 3077: 3075: 3073: 3064: 3060: 3058:9780323089296 3054: 3050: 3049: 3041: 3033: 3029: 3025: 3021: 3017: 3013: 3010:(7): 621–31. 3009: 3005: 2998: 2990: 2986: 2982: 2978: 2974: 2970: 2966: 2962: 2954: 2946: 2942: 2938: 2934: 2930: 2926: 2922: 2918: 2911: 2903: 2899: 2895: 2891: 2887: 2883: 2879: 2875: 2868: 2860: 2856: 2851: 2846: 2842: 2838: 2837: 2832: 2825: 2817: 2813: 2808: 2803: 2799: 2795: 2791: 2784: 2776: 2770: 2766: 2759: 2751: 2747: 2742: 2737: 2733: 2729: 2725: 2721: 2717: 2710: 2702: 2696: 2692: 2685: 2683: 2681: 2679: 2670: 2664: 2660: 2653: 2651: 2649: 2647: 2645: 2643: 2634: 2630: 2625: 2620: 2615: 2610: 2606: 2602: 2598: 2591: 2583: 2579: 2575: 2571: 2567: 2563: 2558: 2550: 2542: 2538: 2533: 2528: 2524: 2520: 2516: 2509: 2501: 2497: 2490: 2482: 2478: 2474: 2471:(5): 1010–2. 2470: 2466: 2462: 2455: 2453: 2444: 2440: 2435: 2430: 2426: 2422: 2418: 2414: 2410: 2403: 2401: 2399: 2390: 2386: 2382: 2378: 2374: 2370: 2366: 2362: 2355: 2353: 2351: 2349: 2347: 2345: 2343: 2341: 2339: 2337: 2335: 2333: 2331: 2329: 2327: 2325: 2323: 2321: 2319: 2317: 2315: 2313: 2311: 2309: 2307: 2305: 2296: 2290: 2286: 2279: 2277: 2275: 2273: 2264: 2260: 2255: 2250: 2246: 2242: 2238: 2234: 2230: 2223: 2221: 2219: 2217: 2215: 2213: 2211: 2202: 2198: 2194: 2190: 2186: 2182: 2175: 2173: 2171: 2169: 2167: 2165: 2163: 2161: 2159: 2157: 2155: 2153: 2151: 2149: 2147: 2145: 2143: 2141: 2139: 2137: 2135: 2133: 2131: 2129: 2127: 2125: 2120: 2112: 2110: 2106: 2102: 2099:, working in 2098: 2094: 2090: 2085: 2083: 2082:xanthochromia 2079: 2075: 2071: 2067: 2064:physician Dr 2063: 2059: 2049: 2046: 2044: 2040: 2036: 2032: 2028: 2024: 2020: 2014: 2012: 2008: 2002: 1999: 1990: 1981: 1979: 1975: 1971: 1967: 1963: 1959: 1955: 1951: 1947: 1943: 1939: 1935: 1927: 1923: 1914: 1912: 1911:hyperglycemia 1908: 1904: 1899: 1897: 1893: 1887: 1885: 1881: 1880:mesencephalon 1877: 1876:hydrocephalus 1871: 1869: 1865: 1861: 1857: 1853: 1850: 1846: 1845:liver disease 1842: 1838: 1834: 1819: 1817: 1813: 1810: 1805: 1803: 1799: 1795: 1792:, as well as 1791: 1787: 1783: 1779: 1775: 1774:Hydrocephalus 1766: 1764: 1760: 1755: 1753: 1749: 1745: 1740: 1737: 1732: 1730: 1724: 1722: 1718: 1714: 1710: 1706: 1702: 1697: 1695: 1691: 1690:oxyhemoglobin 1687: 1683: 1679: 1675: 1671: 1667: 1663: 1658: 1656: 1651: 1647: 1643: 1640: 1636: 1632: 1623: 1620: 1619:relative risk 1616: 1612: 1608: 1604: 1600: 1596: 1592: 1588: 1583: 1581: 1577: 1573: 1569: 1565: 1561: 1557: 1553: 1549: 1545: 1541: 1537: 1532: 1529: 1525: 1521: 1516: 1514: 1510: 1506: 1498: 1494: 1490: 1486: 1477: 1475: 1471: 1467: 1463: 1459: 1454: 1452: 1448: 1444: 1441:, or both. A 1440: 1436: 1432: 1428: 1424: 1420: 1416: 1412: 1408: 1404: 1400: 1396: 1392: 1387: 1385: 1374: 1372: 1368: 1362: 1360: 1356: 1354: 1350: 1341: 1338: 1328: 1325: 1322: 1321: 1317: 1314: 1311: 1310: 1306: 1303: 1300: 1299: 1295: 1292: 1289: 1288: 1284: 1281: 1278: 1277: 1273: 1270: 1266: 1263: 1261: 1256: 1254: 1244: 1240: 1237: 1236: 1229: 1228: 1224: 1221: 1220: 1217:None evident 1216: 1213: 1212: 1208: 1204: 1201: 1193: 1191: 1187: 1183: 1180: 1179: 1175: 1172: 1168: 1165: 1164: 1160: 1157: 1151: 1150: 1146: 1144: 1141: 1140:cranial nerve 1137: 1133: 1130: 1129: 1125: 1122: 1119: 1116: 1115: 1111: 1108: 1104: 1101: 1099: 1094: 1092: 1082: 1080: 1076: 1072: 1068: 1064: 1060: 1056: 1055:QRS complexes 1052: 1048: 1043: 1041: 1037: 1033: 1029: 1025: 1021: 1013: 1004: 1002: 998: 994: 993:centrifugated 990: 989:xanthochromia 985: 982: 978: 974: 970: 966: 962: 955: 954:Xanthochromia 951: 942: 938: 936: 935:radiocontrast 932: 931:blood vessels 929:(visualizing 928: 924: 920: 909: 907: 902: 898: 894: 884: 882: 878: 874: 869: 867: 863: 859: 855: 851: 843: 839: 834: 825: 823: 819: 815: 811: 810:prostaglandin 807: 803: 802:free radicals 799: 795: 791: 780: 778: 774: 770: 766: 765:anticoagulant 762: 758: 754: 752: 748: 744: 740: 736: 731: 729: 725: 721: 717: 712: 710: 706: 702: 693: 684: 680: 678: 673: 671: 667: 663: 660: 656: 652: 648: 644: 640: 636: 632: 628: 627:contractility 624: 619: 615: 609: 607: 603: 599: 595: 591: 587: 585: 581: 577: 576:vitreous body 573: 569: 565: 561: 557: 553: 548: 546: 542: 538: 534: 530: 526: 516: 514: 511: 507: 503: 499: 495: 491: 487: 483: 479: 476: 472: 469:, such as by 468: 464: 460: 456: 452: 447: 445: 441: 435: 433: 429: 425: 421: 417: 413: 408: 406: 402: 398: 394: 390: 386: 381: 379: 375: 371: 367: 363: 359: 355: 351: 347: 343: 339: 330: 326: 322: 320: 316: 313: 309: 306: 304: 300: 297: 293: 290: 286: 283: 279: 275: 272: 270: 266: 263: 259: 256: 254: 250: 247: 243: 239: 235: 232: 230: 226: 223: 219: 216: 212: 208: 204: 201: 197: 193: 189: 187: 186:Complications 183: 180: 176: 172: 169: 167: 163: 160: 156: 153: 151: 147: 138: 71: 70: 68: 66:Pronunciation 64: 60: 55: 51: 46: 42: 38: 33: 27: 24: 19: 7482:Neurosurgery 7449: 7407:Nerve injury 7275: 7262:Extra-axial 7247:Intra-axial 7083:Subarachnoid 7082: 6658: 6647: 6623: 6612: 6601: 6578: 6555: 6499: 6495: 6489: 6475:(5): 17–23. 6472: 6468: 6462: 6427: 6423: 6413: 6388: 6384: 6378: 6343: 6339: 6329: 6312: 6308: 6302: 6293: 6289: 6283: 6256: 6252: 6212: 6208: 6198: 6163: 6159: 6113: 6109: 6099: 6064: 6060: 6050: 6015: 6011: 6001: 5968: 5964: 5958: 5931: 5927: 5917: 5890: 5886: 5848: 5842: 5818:(3): 583–7. 5815: 5811: 5801: 5774: 5770: 5722: 5718: 5712: 5679: 5675: 5669: 5636: 5632: 5626: 5593: 5589: 5579: 5554: 5551:Neurosurgery 5550: 5513: 5509: 5499: 5472: 5468: 5458: 5444:cite journal 5417: 5414:Neurosurgery 5413: 5403: 5389:cite journal 5354: 5350: 5339: 5325:cite journal 5292: 5288: 5281: 5248: 5244: 5238: 5213: 5209: 5186:cite journal 5151: 5147: 5137: 5075: 5069: 5047:(1): 23–56. 5044: 5040: 5034: 5001: 4997: 4991: 4977:cite journal 4944: 4940: 4934: 4891: 4887: 4845: 4841: 4831: 4809:(2): 500–8. 4806: 4802: 4795: 4768: 4764: 4754: 4719: 4715: 4705: 4672: 4668: 4629: 4625: 4584:(5): 654–9. 4581: 4577: 4519: 4515: 4505: 4493:. Retrieved 4489:the original 4484: 4475: 4450: 4446: 4439: 4412: 4408: 4368: 4364: 4354: 4333: 4329: 4289: 4286:Neurosurgery 4285: 4240:(11): 1457. 4237: 4233: 4223: 4196: 4192: 4182: 4157: 4154:Neurosurgery 4153: 4147: 4117:(1): 14–20. 4114: 4110: 4104: 4067: 4063: 4050: 4031: 4025: 4012: 3981: 3975: 3965: 3935:(2): 110–8. 3932: 3928: 3922: 3887: 3883: 3873: 3859:cite journal 3837:(1): 49–58. 3834: 3830: 3824: 3810:(2): 93–95. 3807: 3803: 3797: 3764: 3760: 3754: 3719: 3715: 3675: 3671: 3661: 3648: 3644: 3634: 3609: 3605: 3568: 3564: 3519:(3): 750–5. 3516: 3512: 3502: 3469: 3465: 3418:(7): 866–9. 3415: 3411: 3368:(3): 544–9. 3365: 3361: 3317: 3313: 3303: 3284: 3280: 3234: 3230: 3224: 3189: 3185: 3175: 3142: 3138: 3092: 3088: 3047: 3040: 3007: 3003: 2997: 2964: 2961:Neurosurgery 2960: 2953: 2923:(2): 78–84. 2920: 2916: 2910: 2877: 2873: 2867: 2843:(3): 87–92. 2840: 2834: 2824: 2797: 2793: 2783: 2764: 2758: 2726:(3): 491–3. 2723: 2719: 2709: 2690: 2658: 2604: 2600: 2590: 2568:(1): 25–37. 2565: 2561: 2549: 2522: 2518: 2508: 2499: 2489: 2468: 2464: 2419:(6): 455–8. 2416: 2412: 2364: 2360: 2284: 2236: 2232: 2184: 2180: 2105:Microsurgery 2097:Walter Dandy 2093:neurosurgeon 2086: 2055: 2047: 2015: 2003: 1995: 1984:Epidemiology 1946:hypothalamus 1931: 1900: 1888: 1872: 1841:heart attack 1830: 1809:preventative 1806: 1772: 1756: 1752:hypervolemia 1748:hypertension 1741: 1733: 1725: 1716: 1698: 1662:endothelin 1 1659: 1646:brain damage 1642:brain injury 1629: 1606: 1584: 1576:neurosurgeon 1533: 1517: 1502: 1492: 1455: 1388: 1380: 1363: 1357: 1347: 1334: 1257: 1250: 1199: 1121:Asymptomatic 1095: 1088: 1065:and delayed 1044: 1040:heart attack 1036:ST elevation 1018: 986: 973:spinal canal 959: 939: 915: 890: 870: 847: 818:prostacyclin 814:nitric oxide 806:endothelin-1 786: 755: 732: 713: 698: 681: 674: 610: 588: 558:may reflect 549: 522: 448: 436: 412:neurosurgery 409: 382: 368:, vomiting, 341: 337: 336: 292:Neurosurgery 229:Risk factors 155:Neurosurgery 26: 18: 7487:Neurotrauma 7388:Tetraplegia 7227:Neurotrauma 7066:Extra-axial 6958:precerebral 6649:MedlinePlus 4947:(1): 1–11. 4632:(1): 8–14. 4074:: 110–118. 3988:: 296–298. 3400:Connolly ES 3320:(1): 1–11. 2794:Circulation 2500:Radiopaedia 2070:neurologist 2058:Hippocrates 2039:cholesterol 1852:circulation 1763:Angioplasty 1759:vasodilator 1699:The use of 1513:nicardipine 1489:Arteriogram 1243:parenchymal 1184:Deep coma; 1059:ST segments 963:, in which 912:Angiography 901:sensitivity 747:spinal cord 677:hemiparesis 666:capillaries 482:intravenous 461:within the 455:attenuation 385:head injury 218:Head injury 40:Other names 7456:Categories 7373:Paraplegia 7298:Concussion 6929:Cerebellum 6847:Brain stem 6775:including 6732:Audio help 6723:2008-08-09 6625:DiseasesDB 4160:(1): 1–9. 2115:References 1864:ventricles 1709:nimodipine 1672:known as ( 1635:blood flow 1548:craniotomy 1451:Antiemetic 1415:parenteral 1245:extension 1136:neurologic 850:meningitis 759:abuse and 659:neurogenic 580:fundoscopy 494:meningitis 424:Nimodipine 312:nimodipine 303:Medication 274:Meningitis 242:alcoholism 21:See also: 7111:Brainstem 6886:Foville's 6671:emerg/559 6668:neuro/357 6660:eMedicine 5965:Neurology 5420:: N3–N4. 5381:212569228 5317:208870207 5120:ignored ( 5110:cite book 4803:Radiology 4447:Radiology 2607:(1): 32. 2494:Dixon A. 2109:vasospasm 2101:Baltimore 2062:Edinburgh 2007:menopause 1998:incidence 1856:vasospasm 1849:posterior 1833:mortality 1822:Prognosis 1794:pneumonia 1717:traumatic 1686:bilirubin 1631:Vasospasm 1626:Vasospasm 1562:and both 1509:labetalol 1495:) of the 1435:pneumatic 1391:intubated 1384:vasospasm 1377:Treatment 1349:Screening 1112:Survival 1098:Botterell 1001:bilirubin 828:Diagnosis 767:therapy, 735:angiogram 631:ventricle 545:meningism 537:Confusion 510:bilateral 492:, severe 432:vasospasm 420:labetalol 358:pia mater 348:into the 328:Frequency 319:Prognosis 308:Labetalol 288:Treatment 159:Neurology 150:Specialty 7149:Aneurysm 7078:Subdural 7073:Epidural 6902:Midbrain 6734: · 6665:med/2883 6370:19983808 6231:23704101 6190:17470467 6132:17895459 6091:12023423 6034:19390078 5985:17709709 5950:17332451 5909:16282541 5834:15662039 5793:17569871 5747:18547651 5739:17763834 5704:24028808 5696:16424735 5661:37400347 5653:17695377 5618:38149776 5610:14505583 5532:27173669 5491:19875741 5436:28873993 5373:32138631 5309:31812149 5273:43488740 5265:17110283 5170:17392694 5102:21116908 5061:15626454 5026:23446475 5018:16265315 4969:23626380 4961:18709660 4918:17636626 4864:12775880 4823:17293572 4787:17395870 4746:30110521 4697:18777412 4689:16139655 4608:17857170 4556:24911172 4516:PLOS ONE 4467:20634431 4387:15086900 4346:Archived 4342:14752379 4215:11546890 4096:13925503 4088:16159052 4004:26381258 3957:13925503 3949:16159052 3906:13330192 3781:19818236 3746:24393459 3738:18482910 3694:24635988 3653:Archived 3626:20370785 3587:31543134 3535:26797666 3494:45645505 3486:16436770 3434:14970066 3404:Mayer SA 3342:23626380 3334:18709660 3251:18309525 3208:28341753 3167:23726077 3159:16759448 3063:Archived 3024:16781992 2989:38900336 2981:11844260 2945:29858980 2937:16543780 2902:20268064 2894:17290097 2859:18066655 2816:16286583 2750:14966173 2633:30039044 2582:24370126 2541:12591643 2481:Archived 2477:11337350 2389:29126514 2381:17258671 2263:27306497 2201:27741994 2013:levels. 2011:estrogen 1960:such as 1948:and the 1938:sequelae 1884:ischemia 1843:or SAH; 1802:Seizures 1639:ischemic 1568:platinum 1540:clipping 1520:hematoma 1423:sedation 1307:Present 1190:moribund 975:using a 923:catheter 897:contrast 854:migraine 739:midbrain 720:arteries 552:dilation 533:seizures 459:CT scans 378:seizures 356:and the 346:bleeding 278:migraine 200:seizures 190:Delayed 175:vomiting 166:Symptoms 7128:General 7034:CADASIL 6860:Medulla 6721: ( 6692:minutes 6619:D013345 6524:1628687 6516:6234754 6481:6228084 6454:2496789 6445:1835889 6405:4654697 6361:2201441 6275:3890278 6181:2095631 6082:1737916 6042:7684816 5993:8596810 5586:Belli A 5584:Sen J, 5571:7133349 5230:6338383 5178:6830602 4926:1767194 4909:7044719 4737:6513627 4646:2045924 4599:1386933 4547:4049799 4524:Bibcode 4495:14 June 4431:9867550 4308:9588539 4264:3236024 4255:1032822 4174:7354892 4139:2871628 4131:5635959 3914:8830952 3851:7897337 3816:5033416 3789:9169045 3543:7268382 3382:8610327 3310:Belli A 3259:8755665 3111:8362440 3032:5511658 2741:1738971 2624:6032606 2532:7974121 2443:2199609 2434:1014202 2254:5018921 2052:History 2019:smoking 1934:fatigue 1926:Autopsy 1705:calcium 1544:coiling 1419:codeine 1296:Absent 1285:Absent 1051:J waves 1028:Q waves 971:of the 887:Imaging 757:Cocaine 728:Aspirin 670:alveoli 629:of the 614:medulla 529:occiput 401:CT scan 397:cocaine 258:CT scan 246:cocaine 238:smoking 6777:stroke 6654:000701 6608:105800 6522: 6514: 6479: 6452: 6442: 6403: 6368: 6358: 6296:: 101. 6273: 6253:Stroke 6229: 6209:Stroke 6188: 6178: 6130: 6089: 6079: 6040: 6032: 6012:Stroke 5991: 5983: 5948: 5928:Stroke 5907: 5887:Stroke 5855: 5832: 5812:Stroke 5791: 5771:Stroke 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214:Causes 141: 7173:Other 7027:Other 6794:Brain 6630:12602 6597:852.1 6593:852.0 6574:S06.6 6570:P10.3 6520:S2CID 6038:S2CID 5989:S2CID 5743:S2CID 5700:S2CID 5657:S2CID 5614:S2CID 5377:S2CID 5313:S2CID 5269:S2CID 5174:S2CID 5022:S2CID 4965:S2CID 4922:S2CID 4693:S2CID 4135:S2CID 4092:S2CID 4070:(2). 4060:(PDF) 4022:(PDF) 3984:(2). 3953:S2CID 3910:S2CID 3785:S2CID 3742:S2CID 3651:(7). 3539:S2CID 3490:S2CID 3338:S2CID 3287:(4). 3255:S2CID 3212:S2CID 3163:S2CID 3028:S2CID 2985:S2CID 2941:S2CID 2898:S2CID 2855:S2CID 2385:S2CID 1974:SIADH 1968:, or 1868:fever 1786:shunt 1556:aorta 1534:If a 1421:, as 1399:pulse 1326:<7 1304:13–14 1293:13–14 1143:palsy 933:with 598:palsy 596:) or 508:, or 374:fever 362:brain 344:) is 206:Types 59:sulci 6877:Pons 6614:MeSH 6603:OMIM 6584:9-CM 6512:PMID 6477:PMID 6450:PMID 6401:PMID 6366:PMID 6271:PMID 6227:PMID 6186:PMID 6128:PMID 6110:JAMA 6087:PMID 6030:PMID 5981:PMID 5946:PMID 5905:PMID 5853:ISBN 5830:PMID 5789:PMID 5735:PMID 5692:PMID 5649:PMID 5606:PMID 5567:PMID 5528:PMID 5487:PMID 5450:link 5432:PMID 5395:link 5369:PMID 5331:link 5305:PMID 5261:PMID 5226:PMID 5192:link 5166:PMID 5129:link 5122:help 5098:PMID 5088:ISBN 5057:PMID 5014:PMID 4983:link 4957:PMID 4914:PMID 4892:2007 4860:PMID 4819:PMID 4783:PMID 4742:PMID 4720:2018 4685:PMID 4642:PMID 4604:PMID 4552:PMID 4497:2013 4463:PMID 4427:PMID 4383:PMID 4338:PMID 4304:PMID 4260:PMID 4211:PMID 4170:PMID 4127:PMID 4084:PMID 4000:PMID 3945:PMID 3902:PMID 3865:link 3847:PMID 3812:PMID 3777:PMID 3734:PMID 3690:PMID 3622:PMID 3583:PMID 3531:PMID 3482:PMID 3430:PMID 3412:JAMA 3378:PMID 3330:PMID 3247:PMID 3204:PMID 3155:PMID 3107:PMID 3053:ISBN 3020:PMID 2977:PMID 2933:PMID 2890:PMID 2812:PMID 2769:ISBN 2746:PMID 2695:ISBN 2663:ISBN 2629:PMID 2578:PMID 2537:PMID 2473:PMID 2439:PMID 2377:PMID 2289:ISBN 2259:PMID 2197:PMID 2080:and 2072:Sir 1976:and 1796:and 1688:and 1601:and 1542:and 1393:and 1315:7–12 1271:GCS 1194:10% 1176:20% 1161:50% 1147:60% 1126:70% 1077:and 1057:and 816:and 771:and 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