Bleeding under spiders Part 1: The concept and causes of the disease

Article by Dr Vu Duy Dung – General Internal Medicine Department – Share99 Times City International Health Hub

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Subarachnoid hemorrhage (SAH) is a brain bleeding stroke and a neurological emergency with a high rate of disability and mortality. This article sums up the most common neurological and medical complications that are potentially life-threatening to increase the likelihood of early recognition of those complications and the prevention of second-degree brain damage.

1. Introduction to srachnoid bleeding

Non-traumatic srachnoid bleeding (SAH) is a cerebral bleeding stroke usually caused by a vesic (berry-shaped) aneurysm rupture and accounts for about 3% of all strokes. While a 17% to 50% reduction in mortality worldwide has been reported in the last 2 to 3 decades, which is believed to be due to faster diagnosis and a more improved treatment strategy, mortality rates before the hospital and within 30 days remain high (15% and 35% respectively). SAH's annual incidence hasn't decreased, which is 9 in 100,000 people in the U.S. and approximately 600,000 worldwide.

Despite the reduction in mortality, SAH remains a highly devastating disease. Surviving patients often carry permanent disabilities, mental deficiencies (particularly executive function and short-term memory), and mental health symptoms (e.g., depression, anxiety), which leads to a meaningful decrease in health-related quality of life, which has been reported in 35% of patients a year after SAH. The average age at the time of aneurysm rupture is 53 years; SAH on-board at an age like this leads to high social costs and years of labor loss.

2. Causes of bleeding under spiders

brain aneurysm

Rupture of brain aneurysms can lead to damage to a patient's heart muscle

The most common cause of SAH is rupture of a brain aneurysm (85%); however, despite modern neuroblematic techniques, 10% of SAH does not find the source of bleeding, in which gas has a small fraction of cases (5%) may be due to other vascular causes (e.g., arterial malformation, arterial arterial contravenous, reversible cerebral spasm syndrome [RCVS]). Especially in RCVS, high cerebral convex SAH expression, rather than SAH in the base tanks, along with typical sausage-shaped spasms/dilation areas on the described vascular image.

There are many epidemiological and gene risk factors for SAH that have been identified. Notably, SAH has female superiority (female-male ratio is 1.6:1), African American, and Hispanic and Portuguese. Hypertension, smoking, and high alcohol use are alterable risk factors that double the risk of SAH in a particular individual. Many other risk factors for genes that cannot be changed are also clear. Patients are advised to seek advice on alterable risk factors to reduce SAH risk.

Current guidelines recommend aneurysm screening if the patient has two or more first-generation relatives with an aneurysm or SAH. This is based on numerous extended cohort screening studies from the Family In-Skull Aneurysm Study and the International Study of Aneurysms in the Skull that have not yet ruptured. Notably, you are more likely than the child of an SAH patient to detect an aneurysm in the skull that has not yet ruptured.

There have been numerous genetic studies of ruptured and un-ruptured cranial aneurysms using connecting and contact genetic approaches across the genome. AHA's guidance for managing patients with un-ruptured in-skull aneurysms also provides a brief overview of current information about the genotype of aneurysms in the skull and SAH. While a combined analysis of aneurysms in the skull both ruptured and un-ruptured identified interleukin-6 gene polythronitis (IL6) at the G572C site (on chromo chromotype No. 7) that increased the risk of aneurysm formation, no important gene risk factors have been identified. Many other mononucleotide polytheses are associated with aneurysm formation, with the strongest collity on chromotype 9 (near cdkn2B reverse circuit suppressor gene), chromotype 8 (near sox17 code-conditioning gene), and chromotype 4 (near EDNRA gene).

Controversies around the genetics of aneurysms and SAH, and numerous studies, including the study of twins, have suggested that environmental risk factors (many of which can be altered) are more important than family genetic factors or gene factors. A recent overview suggests that the family factor is not comparable to the gene factor because following the family is a set of risk factors (such as smoking and hypertension). Currently, routine gene screening is not carried out.

SAH remains one of the leading neurological emergency treated in a neuro-active treatment unit. Neuroscular specialists need to be familiar with this pathology with a high incidence of disability, especially in the light age of the science of post-SAH post-SAH brain damage and changes in classical training on the causes of vascular spasms and late ischemia.

The level phase of SAH can be divided into two: (1) quick evaluation, recognition and diagnosis; immediately transfer to the appropriate SAH center; and timely treatment of the origin of bleeding and (2) close monitoring in a neuro-active treatment unit with expertise in SAH and comprehensive good neurological positive treatment associated with the available treatment guidelines for the prevention or improvement of gynecological and neurological complications.

Source: Susanne Muehlschlegel. Subarachnoid hemorrhage. CONTINUUM (MINNEAP MINN) 2018;24(6, NEUROCRITICAL CARE): 1623–1657

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About: John Smith

b1ffdb54307529964874ff53a5c5de33?s=90&r=gI am the author of Share99.net. I had been working in Vinmec International General Hospital for over 10 years. I dedicate my passion on every post in this site.

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