期刊
LANCET
卷 400, 期 10355, 页码 846-862出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(22)00938-2
关键词
-
资金
- US National Institutes of Health (NIH)
- McDonnell Foundation [NS106014, NS112760, NS113055]
Subarachnoid hemorrhage (SAH) is the third most common subtype of stroke. The incidence has decreased over the years, possibly due to lifestyle changes. A quarter of SAH patients die before hospital admission, and those admitted to the hospital have improved outcomes but may experience long-term neuropsychiatric complications. Severe sudden headache is the most common symptom, and diagnosis is typically made through CT scan and angiography. Treatment focuses on reducing the risk of rebleeding and early aneurysm treatment.
Subarachnoid haemorrhage (SAH) is the third most common subtype of stroke. Incidence has decreased over past decades, possibly in part related to lifestyle changes such as smoking cessation and management of hypertension. Approximately a quarter of patients with SAH die before hospital admission; overall outcomes are improved in those admitted to hospital, but with elevated risk of long-term neuropsychiatric sequelae such as depression. The disease continues to have a major public health impact as the mean age of onset is in the mid-fifties, leading to many years of reduced quality of life. The clinical presentation varies, but severe, sudden onset of headache is the most common symptom, variably associated with meningismus, transient or prolonged unconsciousness, and focal neurological deficits including cranial nerve palsies and paresis. Diagnosis is made by CT scan of the head possibly followed by lumbar puncture. Aneurysms are commonly the underlying vascular cause of spontaneous SAH and are diagnosed by angiography. Emergent therapeutic interventions are focused on decreasing the risk of rebleeding (ie, preventing hypertension and correcting coagulopathies) and, most crucially, early aneurysm treatment using coil embolisation or clipping. Management of the disease is best delivered in specialised intensive care units and high-volume centres by a multidisciplinary team. Increasingly, early brain injury presenting as global cerebral oedema is recognised as a potential treatment target but, currently, disease management is largely focused on addressing secondary complications such as hydrocephalus, delayed cerebral ischaemia related to microvascular dysfunction and large vessel vasospasm, and medical complications such as stunned myocardium and hospital acquired infections.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据