A Simple Guide to Sub-arachnoid Hemorrhage, Diagnosis, Treatment and Related Conditions

By Kenneth Kee

This book describes Sub-arachnoid Hemorrhage, Diagnosis and Treatment and Related Diseases

A Sub-arachnoid Hemorrhage is bleeding into the cerebrospinal fluid filled space between the pial and arachnoid membrane of the brain.

Most sub-arachnoid hemorrhages are caused by trauma.

Aneurysm sub-arachnoid hemorrhage affects a small percentage of this patient population, but is the most troublesome type of sub-arachnoid hemorrhage.

While sub-arachnoid hemorrhage is typical of aneurysm rupture, it often is also linked with intra-ventricular hemorrhage, intra-cerebral hemorrhage, and sub-dural hemorrhage.

The force of the rupture and site of an aneurysm establish the presence of the other hemorrhages.

Non-traumatic sub-arachnoid hemorrhage happens when:

Rupture of a congenital arterial aneurysm (weak arterial wall) is the most frequent cause.
Rupture of an arterial capillary or venous bleeding from one or multiple sites of origin.
This can be from high blood pressure or brain infection.
Capillary damage leading to hemorrhage can happen in certain form of encephalitis.
Hemorrhagic diseases such as dengue fever, hemophilia, thrombocytopenia of unknown origin
Intracranial tumors such as angioblastic meningioma, glioma, pituitary adenoma and intracranial metastases are rare but possible causes.
Anticoagulant therapy particularly over dosage of warfarin
Smoking has been linked with sub-arachnoid hemorrhage.

Several factors are linked with sub-arachnoid hemorrhage such as:
Hypertension,
Cigarette smoking,
Excessive alcohol consumption,
Female gender,
Age,
Genetic syndromes like Ehlers-Danlos, and
Polycystic kidney disease

A normal manifesting symptom is a thunderclap headache.
A headache often is linked with nausea, vomiting, and diplopia (double vision).
Often signs of meningismus (Meningeal signs) are evident due to irritant blood spreading into the fourth ventricle and down the spinal cord irritating nerves and producing neck and back pain.
Cranial nerve deficits can happen.

The early evaluation of a patient suspected of having a sub-arachnoid hemorrhage should involve head computed tomogram

​​​​​​​A CT angiography should be done if a sub-arachnoid hemorrhage is identified

Sub-arachnoid Hemorrhage is an emergency.

Purpose of treatment is to:
Preserve life
Limit the amount of brain damage
Lessen the extent of disability and deformity
Prevent recurrence.

Admission to hospital is necessary to determine
The cause of the Sub-arachnoid Hemorrhage
The extent of damage to the brain using MRI

During the acute phase of Sub-arachnoid Hemorrhage:
A clear airway must be maintained
Adequate fluid and electrolyte intake maintained
Adequate nutrition in the form of glucose, proteins and calories given
Bed rest with adequate nursing care provided
Proper medicines are given

The treatment of sub-arachnoid hemorrhage patients should be done in the intensive care unit.
If there is the presence of hydrocephalus, the placement of an external ventricular drain should be indicated.
The use of nimodipine and euvolemia is important factors to improve outcomes.
Blood pressure should be less than 160 mm Hg and best within the 140-mm Hg range.
Seizure prophylaxis should be started as 20% patients will seize within first 24 hours

Once the Sub-arachnoid Hemorrhage is stable:
The Sub-arachnoid Hemorrhage patient is started on a rehabilitation program.
exercises to strengthen his muscles,
speech training for patients with dysphasia
training on how to perform his daily activities.

TABLE OF CONTENT
Introduction
Chapter 1 Sub-arachnoid Hemorrhage
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Cerebral Aneurysm
Chapter 8 Stroke (Ce

• Language: English
• Publisher: Kenneth Kee
• Release date: Nov 18, 2021
• ISBN: 9781005601386

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

A

Simple

Guide

To

Sub-arachnoid Hemorrhage,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2021 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Sub-arachnoid Hemorrhage, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What You Need to Treat Sub-arachnoid Hemorrhage)

This e-Book is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiography account of my journey as a medical student to family doctor on my other blog: http://afamilydoctorstale.blogspot.com.

This autobiography account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

My diagnosis and treatment capability has improved tremendously from my continued education.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Sub-arachnoid Hemorrhage

(Chapter from A Simple Guide to Sub-arachnoid Hemorrhage 2016 by Kenneth Kee)

What is Sub-arachnoid Hemorrhage?

A Sub-arachnoid Hemorrhage is bleeding into the cerebrospinal fluid filled space between the pial and arachnoid membrane of the brain.

Most sub-arachnoid hemorrhages are caused by trauma.

Aneurysm sub-arachnoid hemorrhage affects a small percentage of this patient population, but is the most troublesome type of sub-arachnoid hemorrhage.

While sub-arachnoid hemorrhage is typical of aneurysm rupture, it often is also linked with intra-ventricular hemorrhage, intra-cerebral hemorrhage, and sub-dural hemorrhage.

The force of the rupture and site of an aneurysm establish the presence of the other hemorrhages.

A good medical history is the first indication to where the sub-arachnoid hemorrhage began.

Spontaneous sub-arachnoid hemorrhage should increase suspicion for aneurysm rupture.

Most aneurysm ruptures happen in patients older than 50 years old.

Incidence of sub-arachnoid hemorrhage in the USA is about 10-14 for 100,000 populations yearly.

The incidence is slightly greater in women, 1.3 compared to men.

It is more frequent in black and Hispanic populations than in white populations.

30% of sub-arachnoid hemorrhage happens during sleep.

Occasionally sub-arachnoid aneurysm hemorrhage happens after a warning sharp, severe headache, or a sentinel headache, that can happen a few weeks before the rupture.

It is difficult to differentiate a sentinel headache from other headaches, but a severe headache in a patient that is not likely to have headaches should raise indication for further imaging.

There is an interesting but not explained fact that most of the aneurysm hemorrhage happens during the spring and autumn season.

While treating a patient with a diagnosis of sub-arachnoid hemorrhage, a doctor should be highly sensitive and promptly assess the patient when changes in mental status are observed.

This patient population is vulnerable to seizures and to hydrocephalus and vasospasm, both possibly damaging factors.

What Causes Sub-arachnoid Hemorrhage?

Causes

Injury to the head produces the highest incidence of sub-arachnoid hemorrhage in the brain.

Non-traumatic sub-arachnoid hemorrhage is mostly caused by vascular malformation such as the rupture of a cerebral aneurysm.

Aneurysm hemorrhage is the main cause in this subgroup.

To a lesser extent, patients have sub-arachnoid hemorrhage after using certain drugs like cocaine.

After doctors finish evaluation in these cases, about 10% do not have clear identifying factors.

Determining the accurate cause of the hemorrhage is very important, as doctors can personalize treatment to the cause of hemorrhage.

Reaction to treatment differs for sub-arachnoid hemorrhage happening from vasospasm.

Non-traumatic sub-arachnoid hemorrhage happens when:

1. Rupture of a congenital arterial aneurysm (weak arterial wall) is the most frequent cause.

2. Rupture of an arterial capillary or venous bleeding from one or multiple sites of origin.

This can be from high blood pressure or brain infection.

3. Capillary damage leading to hemorrhage can happen in certain form of encephalitis.

4. Hemorrhagic diseases such as dengue fever, hemophilia, thrombocytopenia of unknown origin

5. Intracranial tumors such as angioblastic meningioma, glioma, pituitary adenoma and intracranial metastases are rare but possible causes.

6. Anticoagulant therapy particularly over dosage of warfarin

7. Smoking has been linked with sub-arachnoid hemorrhage.

Several factors are linked with sub-arachnoid hemorrhage such as:

1. Hypertension,

2. Cigarette smoking,

3. Excessive alcohol consumption,

4. Female gender,

5. Age,

6. Genetic syndromes like Ehlers-Danlos, and

7. Polycystic kidney disease.

Among the above-stated factors, the history of a previously ruptured intra-cerebral aneurysm is very highly linked with new sub-arachnoid hemorrhage.

The second highest link is between smoking and sub-arachnoid hemorrhage.

Pathophysiology

An early triggering event releases blood into the sub-arachnoid space.

Blood around the brain surface is an irritant, and many complications of sub-arachnoid hemorrhage are due to the irritant effect of blood on the brain.

Reactions of this brain effect are:

1. Seizures,

2. Vasospasm, and

3. Confusion.

Sub-arachnoid hemorrhage