Spontaneous Subarachnoid Hemorrhage

Abstract

As a rule, an attack of spontaneous subarachnoid hemorrhage is characterized by the sudden onset of severe suboccipital or parietal headache, dizziness, nausea, vomiting and somnolence or even coma. If a spinal puncture is done within the first week, one finds an even distribution of blood throughout the fluid and a definite elevation in intraspinal pressure. Unfortunately, this disaster is prone to occur in young adults, rather than in those individuals who have reached the degenerative period of life. Great importance should be attached to the proper diagnosis of the milder cases, particularly in its differentiation from migraine headaches. Recurrences of subarachnoid hemorrhage are the rule, particularly if the patient is not educated to live a quiet life, free from any physical or emotional strain. Even under the best of conditions, the patient usually dies of a second or third massive hemorrhage. While the exciting factor is mainly the increase of intravascular pressure brought about by lifting, straining at stool or emotional excitement, still a few cases in our series experienced the hemorrhage when lying quietly in bed.

Autopsy studies have shown that the vascular weakness is usually congenital in origin. At one or more points where the arteries of the circle of Willis give off branches, there may be an inadequate amount of muscle fibre in the media. As a result of this lack of strength, a small aneurysm forms which often, without any prodromal symptom, ruptures into the subarachnoid space. Unfortunately, these weak spots have no support from. . .