Review Question - QID 101703

The patient has had a subarachnoid hemorrhage (SAH), and arterial vasospasm is the most common complication from this disease.

A subarachnoid hemorrhage is a bleed into the space between the arachnoid and pia mater that can occur spontaneously (typically from a ruptured cerebral aneurysm, such as a berry aneurysm), or from head injury. Arterial vasospasm is the most common complication following SAH, and may occur in >50% of cases. It can cause delayed ischemic brain injury 2-3 days after the initial event, which can lead to permanent impairment or death.

Dachs et al. discuss the sensitivity of non-contrast head CT in ruling out a subarachnoid hemorrhage. They conclude that despite significant advances in CT resolution and slice thinness, in cases where there is a strong suspicion for subarachnoid hemorrhage, a negative CT should still be followed by a lumbar puncture to evaluate for xanthochromia.

Moussouttas et al. discuss the association of early and delayed vasospasm in SAH with acute sympathetic response. They measured circulating catecholamine levels in patients following SAH, and showed that early and delayed vasospasm appear to be unrelated to central sympathetic response.

Illustration A demonstrates a CT scan of a typical subarachnoid hemorrhage. Illustration B shows the most common locations of saccular aneurysms in the brain.

Incorrect answers:
Answer 1: Though this may be a complication of cerebral damage in certain areas, this is not the most common complication.
Answer 3: Because the skull is a closed compartment, it is not possible to lose enough blood in a cerebral bleed to develop shock.
Answer 4&5: These are not complications of subarachnoid hemorrhage.