Perdarahan subarachnoid (subarachnoid hemorrhage/SAH) adalah perdarahan mendadak di celah antara otak dan membran tengah yang membungkus otak. Perdarahan biasanya berasal dari robekan tonjolan abnormal dalam pembuluh darah otak (pembengkakan pada dinding arteri otak) yang berakibat fatal. A Subarachnoid (sub-uh-`rack noid) Hemorrhage (SAH) occurs when a blood vessel either on or inside the brain suddenly begins to leak blood. This blood settles into a space between the surface of the brain and the skull called the subarachnoid space. The leaked blood may also settle into other areas o f the brain, but it is the blood in.

Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space. Subarachnoid bleeding is an emergency and prompt medical attention is needed.

Subarachnoid hemorrhage can be caused by:

• Bleeding from a tangle of blood vessels called an arteriovenous malformation (AVM)
• Bleeding disorder
• Bleeding from a cerebral aneurysm (weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out)
• Head injury
• Unknown cause (idiopathic)
• Use of blood thinners

Subarachnoid hemorrhage caused by injury is often seen in the older people who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes.

Risks include:

• Unruptured aneurysm in the brain and other blood vessels
• Fibromuscular dysplasia (FMD) and other connective tissue disorders
• High blood pressure
• History of polycystic kidney disease
• Smoking
• Use of illicit drugs such as cocaine and methamphetamine
• Use of blood thinners such as warfarin

A strong family history of aneurysms may also increase your risk.

The main symptom is a severe headache that starts suddenly (often called thunderclap headache). It is often worse near the back of the head. Many people often describe it as the 'worst headache ever' and unlike any other type of headache pain. The headache may start after a popping or snapping feeling in the head.

Other symptoms:

• Decreased consciousness and alertness
• Eye discomfort in bright light (photophobia)
• Mood and personality changes, including confusion and irritability
• Muscle aches (especially neck pain and shoulder pain)
• Nausea and vomiting
• Numbness in part of the body
• Stiff neck
• Vision problems, including double vision, blind spots, or temporary vision loss in one eye

Other symptoms that may occur with this disease:

• Sudden stiffening of back and neck, with arching of the back (opisthotonos; not very common)

Signs include:

• A physical exam may show a stiff neck.
• A brain and nervous system exam may show signs of decreased nerve and brain function (focal neurologic deficit).
• An eye exam may show decreased eye movements. A sign of damage to the cranial nerves (in milder cases, no problems may be seen on an eye exam).

If your doctor thinks you have a subarachnoid hemorrhage, a head CT scan (without contrast dye) will be done right away. In some cases, the scan is normal, especially if there has only been a small bleed. If the CT scan is normal, a lumbar puncture (spinal tap) may be done.

Other tests that may be done include:

• Cerebral angiography of blood vessels of the brain
• CT scan angiography (using contrast dye)
• Transcranial Doppler ultrasound, to look at blood flow in the arteries of the brain
• Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) (occasionally)

The goals of treatment are to:

• Save your life
• Repair the cause of bleeding
• Relieve symptoms
• Prevent complications such as permanent brain damage (stroke)

Surgery may be done to:

• Remove large collections of blood or relieve pressure on the brain if the hemorrhage is due to an injury
• Repair the aneurysm if the hemorrhage is due to an aneurysm rupture

If the person is critically ill, surgery may have to wait until the person is more stable.

Surgery may involve:

• Craniotomy (cutting a hole in the skull) and aneurysm clipping, to close the aneurysm
• Endovascular coiling: placing coils in the aneurysm and stents in the blood vessel to cage the coils reduces the risk of further bleeding

If no aneurysm is found, the person should be closely watched by a health care team and may need more imaging tests.

Treatment for coma or decreased alertness includes:

• Draining tube placed in the brain to relieve pressure
• Life support
• Methods to protect the airway
• Special positioning

A person who is conscious may need to be on strict bed rest. The person will be told to avoid activities that can increase pressure inside the head, including:

• Bending over
• Straining
• Suddenly changing position

Treatment may also include:

• Medicines given through an IV line to control blood pressure
• Medicine to prevent artery spasms
• Painkillers and anti-anxiety medicines to relieve headache and reduce pressure in the skull
• Medicines to prevent or treat seizures
• Stool softeners or laxatives to prevent straining during bowel movements
• Medicines to prevent seizures

How well a person with subarachnoid hemorrhage does depends on a number of different factors, including:

• Location and amount of bleeding
• Complications

Older age and more severe symptoms can lead to a poorer outcome.

People can recover completely after treatment. But some people die, even with treatment.

Pdf Perdarahan Subarachnoid De

Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is much worse.

Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.

Other complications include:

• Complications of surgery
• Medicine side effects
• Seizures

Go to the emergency room or call the local emergency number (such as 911) if you or someone you know has symptoms of a subarachnoid hemorrhage.

The following measures may help prevent subarachnoid hemorrhage:

• Stopping smoking
• Treating high blood pressure
• Identifying and successfully treating an aneurysm
• Not using illicit drugs

Mayer SA. Hemorrhagic cerebrovascular disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 408.

Szeder V, Tateshima S, Duckwiler GR. Intracranial aneurysms and subarachnoid hemorrhage. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 67.

Pdf Perdarahan Subarachnoid En

Updated by: Alireza Minagar, MD, MBA, Professor, Department of Neurology, LSU Health Sciences Center, Shreveport, LA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Ahmad Faisal Darmawan, NIM011311133084 (2017)PROFIL KLINIS PASIEN PERDARAHAN SUBARACHNOID DI RSUD DR.SOETOMO SURABAYA PERIODE JULI 2013 – JUNI 2016. Skripsi thesis, Universitas Airlangga.

Abstract

Subarachnoid Hemorrhage is a significant cause of mortality and morbiditythroughout the World and patients who survive usually experience neurological deficit.In addition it happens frequently in women.This research is aimed to find the clinical profile of Subarachnoid Hemorrhagepatients in RSUD Dr. Soetomo Surabaya within July 2013 – June 2016. This researchis an observational – descriptive research. The data collection of this research is totalsampling of Subarachnoid hemorrhage patients in RSUD Dr. Soetomo Surabaya withinJuly 2013 – June 2016.In this research there are 191 patients of Subarachnoid Hemorrhage patients inRSUD Dr. Soetomo Surabaya in July 2013 – June 2016. The number of female patientsis still dominated with a total of 112 patients (59%), while for males in 79 patients(41%). The age group 46-65 is the age range most often found with a number of 118patients (62%). Of the various other risk factors from past medical history, hypertensionis a risk factor that is most commonly experienced by patients with the number of 112patients (73%). Loss of consciousness is the most common symptom seen in patientsupon hospital admission with a number of 109 patients (57%). The number of patientswho had grade 4 WFNS with the number of 82 patients. Surgical therapy is recordedonly 22 patients (11%) who use this therapy. Coilling method is most commonly usedby patients with a number of 20 patients (91%). Because the mortality rate is still quitehigh, outcome death in patients with Subarachnoid Hemorrhage in the Hospital Dr. Soetomo still often the case with the number of 94 patients (49%). The common causesfor the death of a patient due to Cerebral herniation experienced by 75 patients (80%).The mortality of Subarachnoid Hemorrhage patients in RSUD Dr. SoetomoSurabaya in July 2013 – June 2016 is still high; patients who suffer the most based onthe age group are 46 – 65 years old, while based on Sex is Woman.

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