Subarachnoid haemorrhage (SAH)

Shofiana Rahmawati
30101407329
Advisor : dr. Dria Anggraeny S, Sp.Rad
Subarachnoid hemorrhage (SAH) is one of the types
of extra-axial intracranial hemorrhage and denotes the
presence of blood within the subarachnoid space.

Risk factors
•family history
•hypertension
•heavy alcohol consumption
•abnormal connective tissue
• autosomal dominant polycystic kidney disease
• Ehlers-Danlos disease type IV
• Marfan syndrome
• neurofibromatosis type 1
•female gender: ~1.5x baseline risk
•African descent: ~2x baseline risk
•Japanese or Finnish descent
Clinical presentation
Patients typically present with a thunderclap headache,
described as a sudden-onset headache that is the worst
headache of their life. It is often associated
with photophobia and meningism. Focal neurological deficits
often present either at the same time as a headache or soon
thereafter.
In a substantial number of patients (almost half 2), it is
associated with collapse and decreased or loss of
consciousness, even in those patients who subsequently
regain consciousness and have a good grade.
Etiology
•trauma
•spontaneous
• ruptured berry aneurysm: 85%
• perimesencephalic hemorrhage: 10%
• arteriovenous malformation
• cerebral amyloid angiopathy 
• ruptured mycotic aneurysm
• reversible cerebral vasoconstriction syndrome
• dural arteriovenous fistula
• spinal arteriovenous malformation
• venous infarction
• intradural arterial dissection
• pituitary apoplexy
• cocaine use
• cerebral vasculitis
• anticoagulation therapy
Radiographic features
Although MRI is thought to be more sensitive, CT is frequently performed first due to
wider availability. As well as being more sensitive for hemorrhage, MRI has greater
sensitivity to the wide range of causative lesions.
Subarachnoid haemorrhage (SAH)
 Dense material in the basal cisterns and fissures
is due to acute bleeding into the subarachnoid
space
 Blood in the subarachnoid space can fill or partly
fill the sulci, fissures, basal cisterns and ventricles

Clinical information
•Sudden onset of severe - 'worst ever' - headache
 Occasionally blood is seen layered over the
tentorium which appears denser than is normally
seen
 Subarachnoid haemorrhage (SAH)
 Blood in the ventricles may be the only sign of
subarachnoid haemorrhage
 When a CT scan is acquired the patient lies supine
and any blood in the lateral ventricles will collect
posteriorly
 Calcification of the choroid plexus is a normal
finding which should not be mistaken for
intraventricular blood
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