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Cerebral Aneurysm Arteriovenous Malformation: Signs and Symptoms
Cerebral Aneurysm Arteriovenous Malformation: Signs and Symptoms
between the pial and arachnoid membranes (see the image below). It occurs in various clinical contexts, the
most common being head trauma. However, the familiar use of the term SAH refers to nontraumatic (or
spontaneous) hemorrhage, which usually occurs in the setting of a ruptured cerebral aneurysm orarteriovenous
malformation (AVM).
Headache (48%)
Dizziness (10%)
Orbital pain (7%)
Diplopia (4%)
Visual loss (4%)
Signs present before SAH include the following:
Hydrocephalus
Rebleeding
Vasospasm
Seizures
Cardiac dysfunction
See Clinical Presentation for more detail.
Diagnosis
Diagnosis of SAH usually depends on a high index of clinical suspicion combined with radiologic confirmation
via urgent noncontrast CT, followed by lumbar puncture or CT angiography of the brain. After the diagnosis is
established, further imaging should be performed to characterize the source of the hemorrhage.
Laboratory studies should include the following:
Management
Current treatment recommendations include the following:
Antihypertensive agents (eg, IV beta blockers) when mean arterial pressure exceeds 130 mm Hg
Avoidance of nitrates (which elevate ICP) when feasible
Hydralazine and calcium channel blockers
Rebleeding
Vasospasm
Hydrocephalus
Hyponatremia
Seizures
Pulmonary complications
Cardiac complications
Surgical treatment to prevent rebleeding includes the following options: