Discharge And Home Healthcare Guidelines

Subarachnoid

DRG Category: 014

Mean LOS: 6.4 days

Description: MEDICAL: Specific Cerebrovascular

Disorders Except Transient Ischemic Attack

DRG Category: 001

Mean LOS: 9.6 days

Description: SURGICAL: Craniotomy Except for

Trauma, Age > 17 with CC

Subarachnoid hemorrhage (SAH) is the direct hemorrhage of arterial blood into the subarachnoid space. Immediately after rupture, intracranial pressure (ICP) rises, resulting in a fall in

858 Subarachnoid Hemorrhage cerebral perfusion pressure (CPP = mean arterial pressure - ICP). Furthermore, the expanding hematoma acts as a space-occupying lesion, as it compresses or displaces brain tissue. Blood in the subarachnoid space may impede the flow and reabsorption of cerebrospinal fluid (CSF), thus resulting in hydrocephalus. The bleeding ceases with the formation of a fibrin-platelet plug at the point of the rupture and by tissue compression. As the clot, which forms initially to seal the rupture site, undergoes normal lysis or dissolution, the risk of rebleeding increases. More than 27,000 people in the United States have a ruptured intracranial aneurysm each year, although the annual incidence is probably underestimated because death is attributed to other reasons.

Cerebral vasospasm, or narrowing of the vessel lumen, is another common complication of SAH; it occurs in 35% to 49% of individuals. The pathophysiology of vasospasms is not clearly understood, but it is believed that they are precipitated by certain vasoactive substances (e.g., prostaglandins, serotonin, and catecholamines), which are released by the blood into the sub-arachnoid space. When vasospasm develops, it may last for several days or even several weeks. By decreasing cerebral blood flow, a vasospasm produces further neurological deterioration, cerebral ischemia, and cerebral infarction.

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