Numbers
- Common finding in closed head injuries
Pathology
- Due to direct damage to cortical vessels.
- It correlates with poorer outcome and more severe injury
- Presence of SAH reflection of a greater degree of violence at injury rather than being directly responsible for secondary injury.
- In TBI patients matched by GCS, age, sex, and the presence of intracranial mass lesions after blunt head injuries
- Traumatic SAH patients
- Spend more time in the intensive care unit (ICU),
- Are less likely to be discharged home,
- 1.5 times more likely to die during acute hospitalization.
- In penetrating TBI there is a significant correlation between SAH and poor outcome.
- Cortical SAH is associated with progression of adjacent cerebral contusions, suggestive of subarachnoid bleeding in the vault as an early sign of cortical microbleeding and significant intraparenchymal brain damage.
- tSAH may also contribute to secondary insults
- Cerebral swelling,
- Hemodynamically significant vasospasm,
- Disturbances of metabolism and autoregulation
- Due to reduced adaptive thresholds of the brain to additional physiological shifts
- Posttraumatic vasospasm can be observed as early as two days postinjury and reaches maximum intensity between five to seven days
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