Central nervous system disorders

IV./4.3.: Course of the disease

The patient who was admitted with sudden, severe headache should be treated in an intensive care unit if the cranial CT scan shows subarachnoid hemorrhage, or when - in case of negative CT results - the lumbar tap proves subarachnoid bleeding. Developing hydrocephalus considered as an early complication; to monitor the ventricular enlargement control cranial CT scans are recommended, especially when consciousness is altered. In case of subarachnoid hemorrhage related hydrocephalus, early ventricular drainage has proved to have a better outcome.

The phenomenon, called “vasospasm” develops on the forth day of the bleeding and lasts approximately for two weeks. Thromboxan, reactive oxygen species and serotonin released from the blood in the subarachnoid space cause vasospasm, and the secondary ischemic brain damage leads to neurological symptoms. The frequency of ischemic complication is 15-45%. Vasoconstriction is seen in 70% of the subarachnoid hemorrhage patients by classic angiography; however, neurological signs develop in only half of these patients. The vasospasm could be monitored by classic angiography or by a non-invasive method, transcranial Doppler ultrasonography. The presence of vasospasm is clearly visible on the arteries with angiography.

Epileptic seizure develops in 30% of the patients. While the efficacy of preventive antiepileptic treatment was disproved in clinical trials, some authors still apply antiepileptic drugs between 7-14 days of the bleeding, since the convulsions could increase the chance of the rebleeding in this vulnerable period of the illness. Repeated EEG monitoring of comatose subarachnoid hemorrhage patients is recommended, in these cases the frequency of non-convulsive status epilepticus is 20%.