The Diagnosis of Subarachnoid Haemorrhage
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Endoscopic Anatomical Study of the Arachnoid Architecture on the Base of the Skull
DOI 10.1515/ins-2012-0005 Innovative Neurosurgery 2013; 1(1): 55–66 Original Research Article Peter Kurucz* , Gabor Baksa , Lajos Patonay and Nikolai J. Hopf Endoscopic anatomical study of the arachnoid architecture on the base of the skull. Part I: The anterior and middle cranial fossa Abstract: Minimally invasive neurosurgery requires a Introduction detailed knowledge of microstructures, such as the arach- noid membranes. In spite of many articles addressing The arachnoid was discovered and named by Gerardus arachnoid membranes, its detailed organization is still not Blasius in 1664 [ 22 ]. Key and Retzius were the first who well described. The aim of this study is to investigate the studied its detailed anatomy in 1875 [ 11 ]. This description was topography of the arachnoid in the anterior cranial fossa an anatomical one, without mentioning clinical aspects. The and the middle cranial fossa. Rigid endoscopes were intro- first clinically relevant study was provided by Liliequist in duced through defined keyhole craniotomies, to explore 1959 [ 13 ]. He described the radiological anatomy of the sub- the arachnoid structures in 110 fresh human cadavers. We arachnoid cisterns and mentioned a curtain-like membrane describe the topography and relationship to neurovascu- between the supra- and infratentorial cranial space bearing lar structures and suggest an intuitive terminology of the his name still today. Lang gave a similar description of the arachnoid. We demonstrate an “ arachnoid membrane sys- subarachnoid cisterns in 1973 [ 12 ]. With the introduction of tem ” , which consists of the outer arachnoid and 23 inner microtechniques in neurosurgery, the detailed knowledge arachnoid membranes in the anterior fossa and the middle of the surgical anatomy of the cisterns became more impor- fossa. -
Iatrogenic Spinal Subarachnoid Hematoma After Diagnostic Lumbar Puncture
https://doi.org/10.14245/kjs.2017.14.4.158 KJS Print ISSN 1738-2262 On-line ISSN 2093-6729 CASE REPORT Korean J Spine 14(4):158-161, 2017 www.e-kjs.org Iatrogenic Spinal Subarachnoid Hematoma after Diagnostic Lumbar Puncture Jung Hyun Park, Spinal subarachnoid hematoma (SSH) following diagnostic lumbar puncture is very rare. Generally, Jong Yeol Kim SSH is more likely to occur when the patient has coagulopathy or is undergoing anticoagulant therapy. Unlike the usual complications, such as headache, dizziness, and back pain at the Department of Neurosurgery, Kosin needle puncture site, SSH may result in permanent neurologic deficits if not properly treated University Gospel Hospital, Kosin within a short period of time. An otherwise healthy 43-year-old female with no predisposing University College of Medicine, factors presented with fever and headache. Diagnostic lumbar puncture was performed under Busan, Korea suspicion of acute meningitis. Lumbar magnetic resonance imaging was performed due to hypo- Corresponding Author: esthesia below the level of T10 that rapidly progressed after the lumbar puncture. SSH was Jong Yeol Kim diagnosed, and high-dose steroid therapy was started. Her neurological symptoms rapidly deterio- Department of Neurosurgery, rated after 12 hours despite the steroids, necessitating emergent decompressive laminectomy Kosin University Gospel Hospital, and hematoma removal. The patient’s condition improved after the surgery from a preoperative Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan motor score of 1/5 in the right leg and 4/5 in the left leg to brace-free ambulation (motor grade 49267, Korea 5/5) 3-month postoperative. -
Cerebrospinal Fluid in Critical Illness
Cerebrospinal Fluid in Critical Illness B. VENKATESH, P. SCOTT, M. ZIEGENFUSS Intensive Care Facility, Division of Anaesthesiology and Intensive Care, Royal Brisbane Hospital, Brisbane, QUEENSLAND ABSTRACT Objective: To detail the physiology, pathophysiology and recent advances in diagnostic analysis of cerebrospinal fluid (CSF) in critical illness, and briefly review the pharmacokinetics and pharmaco- dynamics of drugs in the CSF when administered by the intravenous and intrathecal route. Data Sources: A review of articles published in peer reviewed journals from 1966 to 1999 and identified through a MEDLINE search on the cerebrospinal fluid. Summary of review: The examination of the CSF has become an integral part of the assessment of the critically ill neurological or neurosurgical patient. Its greatest value lies in the evaluation of meningitis. Recent publications describe the availability of new laboratory tests on the CSF in addition to the conventional cell count, protein sugar and microbiology studies. Whilst these additional tests have improved our understanding of the pathophysiology of the critically ill neurological/neurosurgical patient, they have a limited role in providing diagnostic or prognostic information. The literature pertaining to the use of these tests is reviewed together with a description of the alterations in CSF in critical illness. The pharmacokinetics and pharmacodynamics of drugs in the CSF, when administered by the intravenous and the intrathecal route, are also reviewed. Conclusions: The diagnostic utility of CSF investigation in critical illness is currently limited to the diagnosis of an infectious process. Studies that have demonstrated some usefulness of CSF analysis in predicting outcome in critical illness have not been able to show their superiority to conventional clinical examination. -
What to Expect After Having a Subarachnoid Hemorrhage (SAH) Information for Patients and Families Table of Contents
What to expect after having a subarachnoid hemorrhage (SAH) Information for patients and families Table of contents What is a subarachnoid hemorrhage (SAH)? .......................................... 3 What are the signs that I may have had an SAH? .................................. 4 How did I get this aneurysm? ..................................................................... 4 Why do aneurysms need to be treated?.................................................... 4 What is an angiogram? .................................................................................. 5 How are aneurysms repaired? ..................................................................... 6 What are common complications after having an SAH? ..................... 8 What is vasospasm? ...................................................................................... 8 What is hydrocephalus? ............................................................................... 10 What is hyponatremia? ................................................................................ 12 What happens as I begin to get better? .................................................... 13 What can I expect after I leave the hospital? .......................................... 13 How will the SAH change my health? ........................................................ 14 Will the SAH cause any long-term effects? ............................................. 14 How will my emotions be affected? .......................................................... 15 When should -
Acute Stroke Practice Guidelines for Inpatient Management of Subarachnoid Hemorrhage, PS 01.20 POLICY
OHSU HEALTH CARE SYSTEM PRACTICE GUIDELINES Acute Stroke Practice Guidelines for Inpatient Management of Subarachnoid Hemorrhage, PS 01.20 Last Reviewed Date: 1/29/10 POLICY OHSU Hospitals and Clinics have adopted this practice standard in order to delineate a consistent, evidenced- based approach to treating the patient who presents with signs and symptoms consistent with acute non- traumatic Subarachnoid Hemorrhage (SAH). Although this standard assists in guiding care, responsibility to determine appropriate care for each individual remains with the provider themselves. Outcomes/ Create a multi-disciplinary, evidence-based, approach to the management of acute non- goals traumatic subarachnoid hemorrhage (SAH) patients. Patient plan of care to take into consideration the entire continuum of care from emergency department through rehabilitation. Physician 1. Determine the appropriate unit for admission. Admission Criteria for Neurosciences ICU a. All acute non-traumatic subarachnoid hemorrhage patients (CT or LP positive) will be admitted to the NSICU. b. Patients with only incidentally found unruptured aneurysms do not need ICU care, unless routine post-op ICU care is required, and may be admitted to 10K. ( Physician 2. Complete appropriate physician order set in EPIC: a) NSG: Aneurysmal Subarachnoid Hemorrhage Orders. b) NSG: Craniotomy for Aneurysm: ICU post-op Orders. c) NeuroInterventional Radiology: Ruptured Aneurysm: Post Embolization Orders. d) NSICU: Daily care orders on rounds. Admission orders must include: CBC, CMP (complete metabolic set), PT/INR/PTT, lipid panel, cardiac enzymes, urine toxicology, CXR and EKG. Transthoracic echocardiogram (TTE) and BNP (B- natriuretic peptide) optional. Activity and diet orders, code status, GI and DVT prophylaxis must also be addressed. -
Simultaneous Cranial Subarachnoid Hemorrhage-Subdural Hematoma
Case Report/Olgu Sunumu İstanbul Med J 2021; 22(1): 81-3 DO I: 10.4274/imj.galenos.2020.73658 Simultaneous Cranial Subarachnoid Hemorrhage-Subdural Hematoma and Spinal Subarachnoid Hemorrhage Eşzamanlı Kraniyal Subaraknoid Kanama-Subdural Hematom ve Spinal Subaraknoid Kanama Hatice Kaplanoğlu1, Veysel Kaplanoğlu2, Aynur Turan1, Onur Karacif1 1University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Clinic of Radiology, Ankara, Turkey 2University of Health Sciences Turkey, Keçiören Training and Research Hospital, Clinic of Radiology, Ankara, Turkey ABSTRACT ÖZ Patients with traumatic intracranial subarachnoid hemorrhage Çok nadiren, travmatik intrakraniyal subaraknoid hemorojisi (SAH) rarely develop spinal subarachnoid hemorrhage (SSAH) (SAH) olan hastalarda, doğrudan omurga yaralanması olmadan without direct spinal injury. We present the case of a 76-year- spinal subaraknoid kanama (SSAH) ortaya çıkabilir. Travmatik old male patient with traumatic intracranial SAH and subdural intrakraniyal SAH ve subdural hematomu olan 76 yaşındaki hematoma, back pain and weakness in the both lower erkek hastada, yoğun bakım takibi sırasında travmadan üç gün limbs radiating to the legs three days after the trauma. After sonra bacaklarına yayılan sırt ağrısı ve bilateral alt ekstremitede worsening of pain and numbness, the patient underwent a güçsüzlük ortaya çıktı. Ağrı ve uyuşmanın kötüleşmesi üzerine, lumbar magnetic resonance imaging 7 days after the trauma, travmadan 7 gün sonra hastaya lomber manyetik rezonans in which blood was seen in the spinal canal in the lumbosacral görüntüleme yapıldı. Lumbosakral bölgede intraspinal region. The bleeding was considered SSAH because of the kanama görüldü. Kanamanın sıvı seviyesi göstermesi liquid level. The patient underwent conservative treatment sebebiyle SSAH olarak değerlendirildi. Hasta kardiyak açıdan because the patient was found to be at high cardiac risk and yüksek riskli bulunduğu için ve nörolojik defisiti hafif olduğu the neurological deficit was mild. -
Subarachnoid Hemorrhage (SAH) (A Type of Hemorrhagic Stroke)
Subarachnoid Hemorrhage (SAH) (A type of Hemorrhagic Stroke) A Guide for Patients and Families in the Neurosurgery Intensive Care Unit Department of Neurosurgery Introduction A team of doctors and nurses at The University of Michigan Neurosurgery Intensive Care Unit (Neuro ICU) wrote this booklet for patients who have had a Subarachnoid Hemorrhage (SAH) and for the family members and friends who care about them. The purpose of this booklet is to give answers to questions about the illness and treatment of SAH and about what you can expect during your stay in the Neuro ICU. If you have any additional questions, please ask a Neurosurgery team member. Table of Contents: What is SAH?............................................................................4 What causes SAH?....................................................4 What are the risk factors for SAH?......................5 Treating SAH at the University of Michigan...................6 Reducing possible side-effects………………….8 Preventing a secondary stroke from cerebral vasospasm………………………………………… 8 What you need to know about your hospital stay…..10 How long will it last?.............................................10 The dangers of being bed bound.......................10 How can family and friends help patients achieve the best outcomes?...............................................................10 Your partnership with the Neuro ICU team................ 12 What is the best way to keep informed about a patient’s clinical status?........................................................12 -
Thunderclap Headache and Subarachnoid Hemorrhage
Thunderclap Headache and Subarachnoid Hemorrhage W David Freeman, MD No conflicts of interest or disclosures Subarachnoid Hemorrhage Neurocrit Care. 2017 Sep;27(Suppl 1):116- 123. doi: 10.1007/s12028-017-0458-8. Objectives •Recognize the symptoms (thunderclap headache) and Subarachnoid signs of SAH Hemorrhage •Initiate workup for suspected SAH •Initial management of SAH patient Case • 39 year old woman presents with severe headache, uncertain time of onset, associated with nausea • PMH: long history of migraine headaches • Meds: • Reports taking ibuprofen prior to ED, with moderate improvement of headache • Taking warfarin for a pelvic DVT - year prior during pregnancy • Exam: sleepy, yet follows commands, left eye droop and dilated pupil, moving all extremities • BP 160/95 mmHg, RR 24/min, HR 98/min • Breathing shallow and rapid, airway protection uncertain Initial Checklist in Emergency Dept. ☐ Brain Imaging ☐ Labs: PT/PTT, CBC, electrolytes, BUN, Cr, troponin, toxicology screen ☐ 12 lead ECG ☐ Blood pressure goal established ☐ Consult neurosurgery ☐ Address hydrocephalus SAH Algorithm Neurocrit Care. 2017 Sep;27(Suppl 1):116- 123. doi: 10.1007/s12028-017-0458-8. SAH Symptoms and Signs CLASSIC NOT-SO-CLASSIC Abrupt onset of severe headache (HA), HA is not reported as abrupt (patient may i.e. thunderclap not remember event well) “Worst or first” headache of one’s life HA responds well to non-narcotic that is instantaneously maximal at onset analgesics (“thunderclap” after lightening strike) May have nausea, vomiting and neck pain HA -
Embryology, Anatomy, and Physiology of the Afferent Visual Pathway
CHAPTER 1 Embryology, Anatomy, and Physiology of the Afferent Visual Pathway Joseph F. Rizzo III RETINA Physiology Embryology of the Eye and Retina Blood Supply Basic Anatomy and Physiology POSTGENICULATE VISUAL SENSORY PATHWAYS Overview of Retinal Outflow: Parallel Pathways Embryology OPTIC NERVE Anatomy of the Optic Radiations Embryology Blood Supply General Anatomy CORTICAL VISUAL AREAS Optic Nerve Blood Supply Cortical Area V1 Optic Nerve Sheaths Cortical Area V2 Optic Nerve Axons Cortical Areas V3 and V3A OPTIC CHIASM Dorsal and Ventral Visual Streams Embryology Cortical Area V5 Gross Anatomy of the Chiasm and Perichiasmal Region Cortical Area V4 Organization of Nerve Fibers within the Optic Chiasm Area TE Blood Supply Cortical Area V6 OPTIC TRACT OTHER CEREBRAL AREASCONTRIBUTING TO VISUAL LATERAL GENICULATE NUCLEUSPERCEPTION Anatomic and Functional Organization The brain devotes more cells and connections to vision lular, magnocellular, and koniocellular pathways—each of than any other sense or motor function. This chapter presents which contributes to visual processing at the primary visual an overview of the development, anatomy, and physiology cortex. Beyond the primary visual cortex, two streams of of this extremely complex but fascinating system. Of neces- information flow develop: the dorsal stream, primarily for sity, the subject matter is greatly abridged, although special detection of where objects are and for motion perception, attention is given to principles that relate to clinical neuro- and the ventral stream, primarily for detection of what ophthalmology. objects are (including their color, depth, and form). At Light initiates a cascade of cellular responses in the retina every level of the visual system, however, information that begins as a slow, graded response of the photoreceptors among these ‘‘parallel’’ pathways is shared by intercellular, and transforms into a volley of coordinated action potentials thalamic-cortical, and intercortical connections. -
Effect of Methemoglobin Formation on the MR Appearance of Subarachnoid Hemorrhage1
William G. Bradley, Jr., M.D., Ph.D. Effect of Methemoglobin Formation Paul G. Schmidt, Ph.D. on the MR Appearance of Subarachnoid Hemorrhage1 Subarachnoid hemorrhage has a much T HE EARLIEST reports of magnetic resonance (MR) images of in- higher intensity in magnetic resonance tracranial hemorrhage (1, 2) suggested a relatively intense ap- (MR) images with the passage of time. peanance of the hemorrhage relative to the surrounding brain. This Acute subarachnoid hemorrhage is diff i- was attributed to the short Ti relaxation time of the presumably cult to see; within 1 week its appearance paramagnetic, iron-containing hemoglobin. Figure 1 illustrates this has become intensified on Ti-weighted appearance in a patient imaged 1 week after rupture of an aneurysm images. Different concentrations of blood in an anterior communicating artery, with resulting intraparenchy- and lysed red blood cells in cerebrospinal mal hematoma and subarachnoid hemorrhage. The short Ti charac- fluid (CSF) were examined spectroscopi- ten of the injured area is enhanced relative to surrounding brain on cally but did not significantly alter Ti a Ti-weighted spin-echo image. and T2 relaxation of CSF acutely. Ultra- As experience was gained, subsequent reports (3, 4) indicated violet visible spectroscopy of bloody CSF that acute intracranial hemorrhage could be much more difficult to stored hypoxically for 3 days showed the detect on MR images. This was attributed by Sipponen et al. (3) to a presence of methemoglobin. The iron in lack of Ti shortening during the acute phase; however, they at- methemoglobin is paramagnetic; in com- tempted no explanation of this phenomenon. -
Subarachnoid Trabeculae: a Comprehensive Review of Their Embryology, Histology, Morphology, and Surgical Significance Martin M
Literature Review Subarachnoid Trabeculae: A Comprehensive Review of Their Embryology, Histology, Morphology, and Surgical Significance Martin M. Mortazavi1,2, Syed A. Quadri1,2, Muhammad A. Khan1,2, Aaron Gustin3, Sajid S. Suriya1,2, Tania Hassanzadeh4, Kian M. Fahimdanesh5, Farzad H. Adl1,2, Salman A. Fard1,2, M. Asif Taqi1,2, Ian Armstrong1,2, Bryn A. Martin1,6, R. Shane Tubbs1,7 Key words - INTRODUCTION: Brain is suspended in cerebrospinal fluid (CSF)-filled sub- - Arachnoid matter arachnoid space by subarachnoid trabeculae (SAT), which are collagen- - Liliequist membrane - Microsurgical procedures reinforced columns stretching between the arachnoid and pia maters. Much - Subarachnoid trabeculae neuroanatomic research has been focused on the subarachnoid cisterns and - Subarachnoid trabecular membrane arachnoid matter but reported data on the SAT are limited. This study provides a - Trabecular cisterns comprehensive review of subarachnoid trabeculae, including their embryology, Abbreviations and Acronyms histology, morphologic variations, and surgical significance. CSDH: Chronic subdural hematoma - CSF: Cerebrospinal fluid METHODS: A literature search was conducted with no date restrictions in DBC: Dural border cell PubMed, Medline, EMBASE, Wiley Online Library, Cochrane, and Research Gate. DL: Diencephalic leaf Terms for the search included but were not limited to subarachnoid trabeculae, GAG: Glycosaminoglycan subarachnoid trabecular membrane, arachnoid mater, subarachnoid trabeculae LM: Liliequist membrane ML: Mesencephalic leaf embryology, subarachnoid trabeculae histology, and morphology. Articles with a PAC: Pia-arachnoid complex high likelihood of bias, any study published in nonpopular journals (not indexed PPAS: Potential pia-arachnoid space in PubMed or MEDLINE), and studies with conflicting data were excluded. SAH: Subarachnoid hemorrhage SAS: Subarachnoid space - RESULTS: A total of 1113 articles were retrieved. -
D40. Cerebrospinal Fluid.Pdf
CEREBROSPINAL FLUID D40 (1) Cerebrospinal Fluid (CSF) Last updated: June 3, 2019 PHYSIOLOGY ............................................................................................................................................ 1 CSF PRODUCTION .................................................................................................................................. 1 CSF REABSORPTION ............................................................................................................................... 1 PARAMETERS ........................................................................................................................................... 2 NORMAL ................................................................................................................................................ 2 OPENING PRESSURE ................................................................................................................................ 3 COLOR ................................................................................................................................................... 3 BLOODY CSF ......................................................................................................................................... 3 VISCOSITY & TURBIDITY ....................................................................................................................... 4 CELLS ...................................................................................................................................................