Spontaneous subarachnoid hemorrhage is a bleeding in to the subarachnoid space without trauma. Aneurysms are the underlying cause in 80% of the cases. Among other causes are: arteriovenous malformations, anticoagulation, vasculitis or brain tumor. Spontaneous subarachnoid hemorrhage is a serious disease, where up to half of the patients die. Of those who survive, only half return to work and many have a reduced quality of life. To prevent rebleeding the aneurysm is closed either with endovascular coiling or neurosurgical clipping.

Keywords: Spontaneous subarachnoid haemorrhage, rebleeding, vasospasm, hydrocephalus.

Correspondence: Ólafur Sveinsson, olafur.sveinsson@karolinska.se

Figure I. Shows the most common aneurysmatic locations in the brain. Published with permission from Elsevier.

Figure 2. Shows a perimesencephalic haemorrhage. The patient suffered thunderclap headache with photophobia and nuchal rigidity. The figure shows subarachnoid blood in the interpeduncular cistern, more on the left side (arrow). In this patient the  CT angiography was normal.

Figure 3. An example of a severe subarachnoid haemorrhage which was caused by a aneurysmal rupture on the anterior communicating artery.

Figure 4. Shows subarachnoid haemorrhage which gives an indication that the ruptured aneurysm is located on the middle cerebral artery (arrow), which was confirmed with angiography.

Figure 5. A 3D volume rendered image from a CT angiogram which shows a 7x5x4 mm large aneurysm on the anterior communicating artery (arrow).

Figure 6. Angiography which shows the aneurysm from figure V filled with coils (arrow) and

Figure 7.  An intraoperative picture which shows a clip on a neck of an aneurysm (arrow) on the middle cerebral artery which had bled.

 

Inflammatory lesions of intracerebral vessels

Mycotic aneurysms

Vasculitis (Polyarteritis nodosa, Churg-Strauss syndrome and Wegeners granulomatosis)

Other causes

Arterial dissection

Cerebral arteriovenous malformations

Cerebral dural arteriovenous fistulae

Intracerebral cavernous angiomas

Cerebral venous thrombosis

Cerebral amyloid angiopathy

Moyamoya disease

Pituitary apoplexy

Malignant glioma

Cervical spinal cord haemangioblastoma

Drugs

Cocain

Anticoagulant drugs

Table I. Unusual causes of subarachnoidal haemorhage