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Hemoragia subarahnoidiană

Hemoragia subarahnoidiană. Mi şcov Rareş, MG IV. “ W hen persons in good health are suddenly seized with pains in the head, and straightway are laid down speechless, and breathe with stertor , they die in seven days unless fever comes on.” Hipocrat , “ Aforisme ”. Definiţie.

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Hemoragia subarahnoidiană

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  1. Hemoragia subarahnoidiană Mişcov Rareş, MG IV

  2. “When persons in good health are suddenly seized with pains in the head, and straightway are laid down speechless, and breathe with stertor, they die in seven days unless fever comes on.” Hipocrat, “Aforisme”

  3. Definiţie • Patologie acută cerebrovasculară, care constă în extravazarea sângelui în spaţiul subarahnoidian

  4. Epidemiologie • Vârstă: >50 ani • Incidenţă: 2-22,5/100 000 • Factori de risc: • AHC • Sex: F- status hormonal • APP: HTA, MAV, anevrisme, boli ale ţesutului conjunctiv (Ehler-Danlos IV, Marfan, ADPKD) • CVM: fumat, consum de alcool

  5. Etiologie

  6. Patogeneză • Vasospasm cerebral (CVS) • subangiografic/angiografic/clinic • Funcţional: NO, prostaciclină/ET-1, TxA2 • Structural: infiltrat inflamator acut, mioproliferare, fibroză • Ischemia cerebrală • ConsecutivCVS+autoreglare cerebrală afectată

  7. Semne şi simptome • Cefalalgie • Rigiditate nuchală • Fotofobie • Greaţă şi vărsături • Pierderea conştienţei • Crize epileptice

  8. Investigaţii • CT cu/fără contrast • Puncţia lombară • Angiografie cerebrală • Angio-CT • RMN, DWI, FLAIR • Angio-RMN • EKG

  9. Puncţia lombară

  10. Scale utilizateîn diagnosticare • Glasgow Coma Scale (GCS) • Hunt and Hess Scale • World Federation of Neurological Surgeons Scale (WFNS)

  11. Complicaţii • Reapariţia hemoragiei • Vasospasm • Hidrocefalie • Hiponatremie • Crize epileptice • Complicaţii cardiace şi pulmonare

  12. Tratament • Neurochirurgical: aplicarea unui clip, lavaj cu ser fiziologic sau rTPA al cisternelor • Endovascular: coiling • Ţinte terapeutice • Prevenirea crizelor epileptice: fenitoină, fenobarbital • Starea de greaţă: prometazină • Monitorizare presiune intracraniană: dexametazonă, manitol • Prevenirea ischemiei cerebrale: 3H Therapy • Prevenirea vasospasmului: nimodipină, nicardipină • Managementul dureri: fentanil

  13. Bibliografie • H. Royden Jones Jr. - Netter’s Neurology 2nd Edition, Elsevier Saunders, 2012 • Adam Fisch – Neuroanatomy: Draw it to know it, Oxford Press, 2009 • H. Richard Winn –Youman’s Neurological Surgery 6th Edition, Elsevier Saunders, 2011 • Kathryn L. McCance- Pathophysiology The Biologic Basis for Disease in Adults and Children 6th Edition, Mosby Elsevier, 2010 • J van Gijn, GJE Rinkel – Subarachnoid hemorrhage: diagnosis, causes and management. Brain (2001), 124, 249-278 • http://emedicine.medscape.com/article/247090-overview#aw2aab6b3 • http://emedicine.medscape.com/article/344342-overview • http://www.medscape.com/viewarticle/780438_2

  14. Vă mulţumesc!

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