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Monday, 2 December 2013

Upper head hemorrhaging: Subarachnoid hemorrhage (SAH) - The Diagnosis

Hemorrhaging is also known as bleeding or abnormal bleeding as a result of blood loss due to internal.external leaking from blood vessels or through the skin.
Subarachnoid hemorrhage (SAH)
Subarachnoid hemorrhage (SAH) is defined as a condition of the presence of blood  within the subarachnoid space (the area between the brain and the thin tissues that cover the brain).
Diagnosis
1. Computed tomography (CT) scan or multidetector CT angiography
If your doctor suspects the bleeding is within the brain itself, then CT scan is the best choice. Computed tomography (CT) is the standard diagnostic tool uses X-rays to make detailed pictures of structures inside the skull to check for fractures and bleeding, specially in case of trauma. Scheduled repeat head computed tomography after mild traumatic brain injury has been shown to have limited use for predicting the need for an intervention. CT scan has correctly identified over 95% of cases—especially on the first day after the onset of bleeding. Others suggested that multidetector CT angiography can be used as a primary examination tool in the diagnostic work-up of patients with SAH(15).

2. A Lumbar puncture
If CT scan can not identify the diagnosis, your doctor may suggest a lumbar puncture (spinal tap). In the study to evaluate the Differentiation of early subarachnoid hemorrhage from traumatic lumbar puncture, showed that the 0.3 to 7% hemolysis which occurred was relatively independent both of the time following SAH and of the number of red blood cells (rbc) in the cerebrospinal fluid (CSF). There was, on the other hand, a significant and time-dependent increase in CSF lactate concentration early after SAH, suggesting the potential clinical value of the detection of increased lactate with a relatively normal lactate/pyruvate ratio in hemorrhagic CSF. Until this can be evaluated in human subjects, however, determination of the rbc counts or total hemoglobin concentrations in serially collected samples of CSF remains the best clinical method(16).

3.  ECG
ECG is found to be important in differetiating of SAH. In the study to evaluate all patients admitted to a 31-bed department of intensive care between 1993 and 2000 with acute aneurysmal SAH documented by cerebral angiography or autops, indicated that of 159 patients (49.6 years [range: 20-75]) with acute SAH, 106 (66.7%) had abnormal ECGs (classified by an observer blinded to the patients' clinical course and outcome. Conduction abnormalities were present in 7.5%. Arrhythmias occurred in 30.2%. By univariate analysis, the presence of ST depression was related to outcome as assessed by the Glasgow Outcome Scale (GOS) (15% poor outcome [GOS 4-5] vs. 1% good outcome [GOS 1-3], p<0.05)(17).

4. Etc. 
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Sources
(14a) http://www.ncbi.nlm.nih.gov/pubmed/22135608
(15) http://www.ncbi.nlm.nih.gov/pubmed/20935079
(16) http://www.ncbi.nlm.nih.gov/pubmed/906062
(17) http://www.ncbi.nlm.nih.gov/pubmed/15301889