Subarachnoid Hemorrhage

Traumatic subarachnoid hemorrhage (tSAH) results from the disruption of subarachnoid vessels and presents with blood in the CSF ( Ta.ble 2.4.7.:3.). In one large European head-injury study, one-third of all patients with moderate to severe head injuries demonstrated traumatic subarachnoid hemorrhage on early CT scans, 25 making tSAH the most common CT abnormality finding in patients with moderate to severe TBI. The overall incidence of tSAH is as high 40 percent when including CT abnormalities. When the CT scan is positive for tSAH, the amount of blood seen on the CT scan is inversely related to the presenting GCS and percent of positive outcomes. The outcome of patients with tSAH was significantly worse than that of patients with no SAH on first CT scan. Overall, 60 percent of the former group resulted in an unfavorable outcome defined as death, persistent vegetative state, or severe disability compared to only 30 percent in the latter group. Mortality in the early tSAH group was 42 percent compared to 14 percent in the no SAH group.25 Recent data have demonstrated the use of nimodipine at 2 mg/h for 7 to 10 days followed by 360 mg daily until day 21 to significantly lower this unfavorable outcome by 55 percent compared to the placebo group. 26

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