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Subarachnoid hemorrhage (mechanism of disease)

This is a flowchart on subarachnoid hemorrhage, a type of hemorrhagic stroke, covering the etiology, pathophysiology, and manifestations. ADDITIONAL TAGS: Risk factors / SDOH Cell / tissue damage Structural factors Subarachnoid hemorrhage Medicine / drugs Infectious / microbial Biochem / molecular bio Immunology / inflammation Signs / symptoms Tests / imaging / labs Metabolic / hormonal Genetics / hereditary Flow physiology Pathophysiology Etiology Manifestations Mechanical force transmitted to the brain → trauma (traumatic SAH) Triggers: Caffeine consumption Acute ↑ in blood pressure Fit of anger Physical exertion Hypertension Risk factors: Rupture of … Subarachnoid hemorrhage: bleeding into the subarachnoid space Intracranial aneurysm, usually berry aneurysms (80%), commonly in the circle of Willis, especially anterior circulation Arteriovenous malformation Intracerebral hemorrhage Smoking High alcohol consumption Positive family history Methamphetamines, cocaine Large aneurysms Angioma Neoplasm Cortical thrombosis Infection Nonspontaneous Spontaneous Other causes: Asymptomatic Mild headache +/- nuchal rigidity Moderate to severe headache Nuchal rigidity +/- cranial nerve palsy Confusion Lethargy Mild focal neurologic deficit Stupor Hemiparesis +/- early decerebrate rigidity +/- vegetative disturbance Profound coma Decerebrate posturing Hunt-Hess classification grade: II III IV V Thunderclap headache: severe, sudden, "worst headache of my life," holocephalic, radiates to neck and back Breakdown of blood products in CNS Meningeal irritation → meningeal signs Photophobia Nausea, vomiting Kernig, Brudzinski signs Mass effect Blood irritates brain parenchyma Seizures Low grade, sentinel, "warning" leak of blood Prodromal symptoms days/weeks before SAH Transient diplopia Head CT w/o contrast: hyperdensity (blood) in subarachnoid space (in cerebral sulci) → then +/- CTA, +/- LP