For literature searches we mainly used our personal database of references. This database has been prospectively built by daily search of PubMed in the past 10–15 years, by means of the following terms “subarachnoid hemorrhage [All Fields] OR subarachnoid haemorrhage [All Fields] OR aneurysm [All Fields] OR arteriovenous malformation [All Fields] OR perimesencephalic [All Fields]”. We also searched the Cochrane library with these terms. We mainly selected studies from the past 10 years,
SeminarSubarachnoid haemorrhage
Section snippets
Epidemiology
The incidence of subarachnoid haemorrhage was overestimated until brain imaging allowed accurate distinction between subarachnoid and intracerebral haemorrhage. In most populations the incidence is 6–7 per 100 000 person-years (after adjustment to age-standardised rates),2, 3 but is around 20 per 100 000 in Finland and Japan.2 Thus, a full-time general practitioner with 2000 patients will see, on average, one patient with subarachnoid haemorrhage about every 7–8 years. Although the incidence
Aneurysms
Intracranial aneurysms are not congenital, as was once believed, but develop in the course of life.7 The best estimate of the frequency of aneurysms for an average adult without specific risk factors is 2·3% (95% CI 1·7–3·1); this proportion increases with age.7 Saccular aneurysms arise at sites of arterial branching, usually at the base of the brain, either on the circle of Willis itself or at a nearby branching point (figure 1). Most intracranial aneurysms will never rupture. The rupture risk
Clinical features
Sudden headache is the most characteristic symptom of subarachnoid haemorrhage; in three out of four patients, the onset is within a split second or a few seconds.27 It is the only symptom in about a third of patients in general practice.32 Conversely, in patients who present with sudden headache alone in general practice, subarachnoid haemorrhage is the cause in one in ten patients.32 Apparently, common headaches with an exceptionally rapid onset outnumber subarachnoid haemorrhage in general
Management
Recommendations for general management and nursing are shown in panel 2. On admission, the first concern is to identify the cause of any reduction in consciousness or focal deficit, before these signs are attributed to the effect of the initial event; some of these causes require immediate intervention. In patients who survive the initial hours after the haemorrhage, three main neurological complications can threaten the patient with a ruptured intracranial aneurysm: rebleeding, delayed brain
Prevention
Three categories need to be considered here. First, there are patients with incidental aneurysms. Second, patients with subarachnoid haemorrhage might have one or more unruptured aneurysms. Last, the question of screening for aneurysms arises in patients who survive an episode of subarachnoid haemorrhage, and in first-degree relatives of patients with subarachnoid haemorrhage.
Search strategy and selection criteria
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Characteristics of intracranial aneurysms and subarachnoid haemorrhage in patients with polycystic kidney disease
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Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture
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Neurosurgery
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Pretruncal subarachnoid hemorrhage: an anatomically correct description of the perimesencephalic subarachnoid hemorrhage
Stroke
How often is a perimesencephalic subarachnoid haemorrhage CT pattern caused by ruptured aneurysms?
Acta Neurochir (Wien)
Perimesencephalic hemorrhage and CT angiography: a decision analysis
Stroke
Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache
J Neurol Neurosurg Psychiatry
Acute hydrocephalus in nonaneurysmal perimesencephalic hemorrhage: evidence of CSF block at the tentorial hiatus
Neurology
Outcome in perimesencephalic (nonaneurysmal) subarachnoid hemorrhage: a follow-up study in 37 patients
Neurology
Quality of life after perimesencephalic haemorrhage
J Neurol Neurosurg Psychiatry
Venous drainage in perimesencephalic hemorrhage
Stroke
Seizures at the onset of subarachnoid haemorrhage
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Onset seizures independently predict poor outcome after subarachnoid hemorrhage
Neurology
Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage
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Acute confusional state as presenting feature in aneurysmal subarachnoid hemorrhage: frequency and characteristics
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Delirium in acute subarachnoid haemorrhage
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The diagnosis of subarachnoid haemorrhage
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A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage
J Neurol Neurosurg Psychiatry
The natural history of nontraumatic subarachnoid hemorrhage-related intraocular hemorrhages
Retina
Electrocardiographic changes in patients with acute stroke: a systematic review
Cerebrovasc Dis
Survival of cardiac arrest after aneurysmal subarachnoid hemorrhage
Neurosurgery
Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan?
J Neurol Neurosurg Psychiatry
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