No abstract available.
Subarachnoid Hemorrhage*

Motor weakness is one of the neurological complication that can occur after aneurysmal subarachnoid hemorrhage (SAH); incidence of motor weakness of 14~29% has been reported. Detailed information on the pathogenic mechanism of motor weakness is essential for brain rehabilitation because it enables estimation of the severity of injury, establishment of scientific rehabilitative strategies, and prediction of motor outcomes by clinicians. However, the exact pathogenic mechanisms of motor weakness following aneurysmal SAH have not been clearly elucidated. In this article, 14 previous studies on pathogenic mechanisms in patients with aneurysmal SAH were reviewed according to the location of the lesion (cerebral cortex, brainstem, spinal cord, and peripheral nerve). The following pathogenic mechanisms have been suggested: vasospasm, cerebral ischemia, hydrocephalus, compression of cerebral cortex, neural injury, spinal cord infarction, and radiculo-neuropathy. Considering the high incidence of aneurysmal SAH and motor weakness following aneurysmal SAH, we believe that the pathogenic mechanisms of motor weakness have been relatively understudied. More effort should be taken to investigate this important topic.
Subarachnoid Hemorrhage

No abstract available.
Subarachnoid Hemorrhage*

Introduction: Spontaneous acute subdural hematoma (ASDH) is rare and comprises 2.6% of all ASDH. In one recent study, only 178 spontaneous ASDH were documented. However, only 1 case was attributed to dural arteriovenous fistula (dAVF). Vascular malformations cause less than 10% of subarachnoid hemorrhage (SAH). Spontaneous ASDH and SAH occurring together are extremely rare. Literature is scarce on cases with dAVF of the occipital lobe as a cause of simultaneous spontaneous ASDH and SAH. Objective: This paper aims to present a case of a spontaneous acute subdural hematoma and subarachnoid hemorrhage caused by a dural arteriovenous fistula of the occipital lobe, along with its clinical presentation, diagnosis, and treatment. Case Summary: A 44-year-old Filipino male with no history of trauma presented with severe headache, vomiting, and decreasing sensorium – CT scan revealed acute parenchymal bleed in the left occipital lobe with subarachnoid extension and subdural hematoma in the left fronto-parieto-temporal convexity along the tentorium cerebelli and posterior interhemispheric falx. Due to the location of the lesion seen on the CT scan and the gender distribution, Arteriovenous malformation (AVM) was initially considered, thus proceeded to computed tomography angiogram (CTA) to establish the diagnosis of vascular anomaly, however, revealed dAVF instead. Four-vessel angiogram was done to assess the tributaries of the dAVF and confirmed the diagnosis. Complete obliteration of dAVF of the occipital lobe was done with Onyx Embolization in one session. Conclusion This is the first case of Borden type II, Cognard type IIa+IIb dAVF, as reported in this institution. Although extremely rare as a cause of SAH and ASDH, dAVF should be considered a differential diagnosis in patients with no identifiable common cause of the new onset of severe headache and poor neurologic status.
Subarachnoid Hemorrhage

OBJECTIVE

This study aims to determine the clinical outcome of patients diagnosed with aneurysmal subarachnoid hemorrhage and their association with grading scores.

The authors conducted a single-center cross- sectional study involving patients diagnosed with aneurysmal subarachnoid hemorrhage admitted at Vicente Sotto Memorial Medical Center, Cebu City, Philippines from January 2015 to December 2020.

Out of 240 patients diagnosed with ruptured aneurysms, 215 underwent definitive treatment. The average age was 56 years old, predominantly female with a ratio of 2:1. Most patients were classified with admitting Hunt and Hess grading scale of 2-3 and Fisher grading scale of 3. Females had increased incidence of multiple aneurysms (ratio 3:1) compared to male sex. Among patients, 197 underwent clipping while 18 underwent coiling. Clinical Outcome revealed that 84% had good outcome while 16% had poor outcome. The association between Hunt and Hess grading scale and patient outcome was statistically significant (p < 0.001) as well as for Fisher grading scale and patient outcome (p < 0.001). Fisher grading scale and incidence of clinical vasospasm were also significant (p =0.004).

Higher scores for Hunt and Hess grading scale and Fisher grading scale were associated with poor outcome. Higher Fisher grading scale was associated with the occurrence of clinical vasospasm among patients with ruptured aneurysm. Female sex also had higher aneurysm incidence with complex and more multiple aneurysms as compared to male sex.

We present a 66-year-old male presenting with sudden onset of headache. Medical decompression was done and neuroimaging of plain cranial CT angiogram (CTA) and CT venogram (CTV) showed components of subarachnoid hemorrhage, intracerebral hemorrhage and hyperdense appearance of the superior sagittal sinus and proximal left transverse sinus. The following were done to look for etiologic factors: 1. fungal swab to determine the cause of the intracerebral hemorrhage secondary to venous thrombosis as the patient presented with a chronic history of sinusitis, 2. coagulopathy workup to look for a hypercoagulable state, and 3. workup for systemic disease of autoimmune in etiology. Anticoagulation was safely initiated within several days given the regression of the intracerebral hemorrhage along with stable findings of subarachnoid hemorrhage. Here we report cerebral venous sinus thrombosis rarely presenting as acute subarachnoid hemorrhage and intracerebral hemorrhage.
Subarachnoid Hemorrhage ; Cerebral Hemorrhage

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.
Hemorrhage ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Tarlov Cysts

No abstract available.
Sciatica* ; Siderosis* ; Subarachnoid Hemorrhage

Diagnostic work-up and management of intracranial arachnoid cysts are still controversial. The authors have reported one case of intracranial arachnoid cyst in association with epilepsy. Operative method: craniotomy with penetration.
Subarachnoid Hemorrhage ; Surgery ; Epilepsy

Objective: To study the clinical presentations, diagnosis of spontaneous subarachnoid hemorrhage (SAH) due to ruptured aneurysms. Determine the operative indications, the surgical modalities and timing of operation. Evaluate the outcome of surgical treatment. Method: This study is performed in 73 patients with aneurysmal SAH, who have been underwent the surgical treatment at the Viet Duc hospital, between 1/1998 and 8/2003. 21 patients were retrospectively analyzed and the prospective evaluation has been performed in 52. The surgical outcome is followed up for a mean time of 31 months. Results: 73 patients ranged in age from 13 to 68 years (mean 44.5), with 37 womens and 36 mens.The classic symptoms and signs: severe headache 83.5%, meningeal syndrome 57.5%, deterioration of consciousness 46.6%. Seizures incidence 12.3%. 8.2% patients have a obscure clinical presentation. The overall sensitivity of CT for aneurysmal SAH was 89%. Lumbar puncture was performed on 21 patients, and revealed bloody or xanthchromia spinal fluid. Cerebral arteriography was able to detect the aneurysm on all patients. 6 hydrocephalus and 5 hematomas were operated in urgent conditions. The delayed surgery for ruptured intracranial aneurysms was indicated in 87.6% patients. Direct surgical clipping obliterated 69 aneurysms. GOS at 31 months posthaemorrhage indicated that 86.1% patients experienced good recovery. Conclusion:The clinical presentation of aneurysmal SAH was often typical. CT sacnner was a crucial diagnostic modality of SAH with high sensitivity, and cerebral arteriography was "gold standard" for diag nosis of ruptured intracranial aneurysms. The surgical treatment play an important role for hydrocephalus, intracerebral hematomas and aneurysmal obliteration. Microsurgery for clipping aneurysms was effective method, with low complication. None of the patients had a repeat hemorrhage, and 86.1% patients had a good result.
Subarachnoid Hemorrhage, Therapeutics, Diagnosis