Chapter IV./3.: Radiological aspects of subarachnoid hemorrhage

Kinga Karlinger

IV./3.1.: Introduction

IV./3.1.1.: Spontaneous subarachnoid hemorrhage (SAH)

Most common cause of spontaneous subarachnoid hemorrhages is the rupture of berry aneurysms located on the arterial circle of Willis or on its branches. Additional reasons: AV malformation, angioma, hypertensive hemorrhage, hemorrhage of tumorous origin, embolism, hemorrhagic infarct, hemophilia, anticoagulant therapy, eclampsy, intracranial inflammation, vascular malformations of the spinal cord.

IV./3.1.2.: Localisations of the aneurysms

Anterior communicating artery – 50 %; posterior communicating artery – 10 %; internal carotid artery – 10 %; middle cerebral artery – 10 %; vertebral artery + basilar artery + other localisations + multiple aneurysms – 20 %.

IV./3.1.3.: Symptoms, therapy, complications, prognosis

Notoriously, sudden severe headache is the most frequent symptom: „headache as severe as never happened in my life!”, neck stiffness, vomiting, faint (in appr. half of the cases). Therapeutic solution can be also radiological: catheter guided embolisation of the aneurysm. Serious complication threaten in the first two weeks: the secondary bleeding with a very high mortality, and the angio- or vasospasm. If the angio- or vasospasm is not lethal, very serious ischemic residual symptoms can develop.

The chapter structure

• IV./3.1.: Introduction

  • IV./3.1.1.: Spontaneous subarachnoid hemorrhage (SAH)

  • IV./3.1.2.: Localisations of the aneurysms

  • IV./3.1.3.: Symptoms, therapy, complications, prognosis

• IV./3.2.: Computed tomography – CT

  • IV./3.2.1.: Role of CT in SAH diagnostics

  • IV./3.2.2.: Bleeding severity scale of Fischer

  • IV./3.2.3.: Role of CT in the prognosis of SAH

  • IV./3.2.4.: CT-based differential diagnostics

  • IV./3.2.5.: CT angiography (CTA)

• IV./3.3.: Magnetic resonance imaging – MR

  • IV./3.3.1.: Role of MR in the diagnostics of SAH

  • IV./3.3.2.: MR angiography (MRA)

• IV./3.4.: Digital subtraction angiography – DSA

• IV./3.5.: Ultrasound – US

• IV./3.6.: Take home messages

References