06. tbl. 97. árg. 2011

Spontaneous subarachnoid haemorrhage – review

Sjálfsprottin innanskúmsblæðing – yfirlitsgrein

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
Anticoagulant drugs

Table I. Unusual causes of subarachnoidal haemorhage

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