Hopp til hovedinnhold

Subaraknoidalblødning (SAB)

Sist revidert:
Sist revidert av:
Definisjon:
Akutt intrakraniell blødning fra arterier i subaraknoidalrommet. Ca. 80% skyldes ruptur av aneurisme.
Forekomst:
Insidens: Ca. 8-10 tilfeller per 100.000 innbyggere per år, ca. 500 tilfeller årlig i Norge
Symptomer:
Akutt debut med intens hodepine som utvikles over få minutter, oftest nakkestivhet, kvalme, bevissthetsreduksjon, krampeanfall, ev. lammelser
Funn:
Ved us: nakkestivhet, nedsatt bevissthet, fokale nevrologiske utfall.
Diagnostikk:
Akutt innleggelse ved mistanke om tilstanden. Diagnostiseres med CT
Behandling:
. Symptomatisk behandling for å forebygge reblødning, hjerneødem, hydrocefalus eller andre komplikasjoner. Kirurgisk behandling av aneurisme, endovaskulær coiling eller åpen klipsing. 
  1. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med 2006; 354: 387-96. PubMed  
  2. Cohen-Gadol AA, Bohnstedt BN. Recognition and evaluation of nontraumatic subarachnoid hemorrhage and ruptured cerebral aneurysm. Am Fam Physician. 2013 Oct 1;88(7):451-456. PubMed  
  3. Brown RD Jr, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options and familial screening. Lancet Neurol 2014; 13: 393-404. pmid:24646873 PubMed  
  4. Holtermann MK. Risikofaktorer for subaraknoidalblødning. Tidsskr Nor Legeforen 2012. doi:10.4045/tidsskr.12.0278 DOI  
  5. Claassen J, Park S. Spontaneous subarachnoid haemorrhage. Seminar. Lancet 2022. doi:10.1016/S0140-6736(22)00938-2 DOI  
  6. Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med 2006; 355: 928-39. PubMed  
  7. Wiebers DO, Whisnant JP, Huston J III, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362: 103-10. PubMed  
  8. White PM, Wardlaw J. Unruptured intracranial aneurysms: prospective data have arrived. Lancet 2003; 362: 90-1. PubMed  
  9. Newton T, Krawczyk J, Lavine S. Subarachnoid hemorrhage. eMedicine, April 4, 2002: www.emedicine.com.
  10. Isaksen J, Egge A, Waterloo K, Romner B, Ingebrigtsen T. Risk factors for aneurysmal subarachnoid haemorrhage: the Tromso study. J Neurol Neurosurg Psychiatry. 2002; 73: 185-7. PubMed  
  11. Bakke SJ, Lindegaard K-F. Subaraknoidalblødning - diagnostikk og behandling. Tidsskr Nor Lægeforen 2007; 127: 1074-8. PubMed  
  12. Schievink WI. Intracranial aneurysms. N Engl J Med 1997; 336: 28-40. New England Journal of Medicine  
  13. Broderick JP, Viscoli CM, Brott T, et al.; Hemorrhagic Stroke Project Investigators. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke. 2003;34(6):1375–1381.
  14. Feigin VL, Rinkel GJ, Lawes CM, et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005;36(12):2773–2780.
  15. Anderson C, Ni Mhurchu C, Scott D, Bennett D, Jamrozik K, Hankey G; Australasian Cooperative Research on Subarachnoid Hemorrhage Study Group. Triggers of subarachnoid hemorrhage: role of physical exertion, smoking, and alcohol in the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke. 2003;34(7):1771–1776.
  16. Broderick JP, Viscoli CM, Brott T, et al. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke 2003; 34: 1375-81. Stroke  
  17. Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous subarachnoid hemorrhage: A systematic review and meta-analysis describing the diagnostic accuracy of history, physical exam, imaging, and lumbar puncture with an exploration of test thresholds. Acad Emerg Med 2016. doi: 10.1111/acem.12984 DOI  
  18. Blok KM, Rinkel GJE, Majoie CBLM, et al. CT within 6 hours of headache onset to rule out subarachnoid hemorrhage in nonacademic hospitals. Neurology 2015. DOI: 10.1212/WNL.0000000000001562 DOI  
  19. Edlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med 2000; 342: 29-36. New England Journal of Medicine  
  20. Perry JJ, Stiell IG, Sivilotti ML, et al. High-risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ. 2010;341:c5204. PubMed  
  21. Landtblom AM, Fridriksson S, Boivie J, Hillman J, Johansson G, Johansson I. Sudden onset headache: a prospective study of features, incidence and causes. Cephalalgia. 2002;22(5):354–360.
  22. Bederson JB, Connolly ES Jr, Batjer HH, et al.; American Heart Association. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40(3):994–1025.
  23. Togha M, Sahraian MA, Khorram M, Khashayar P. Warning signs and symptoms of subarachnoid hemorrhage. South Med J. 2009;102(1):21–24.
  24. Leblanc R. The minor leak preceding subarachnoid hemorrhage. J Neurosurg 1987; 66: 35-9. PubMed  
  25. Polmear A. Sentinel headaches in aneurysmal subarachnoid hemorrhage: what is the true incidence? A systematic review. Cephalalgia 2003; 23: 935-41. PubMed  
  26. Perry JJ, Sivilotti MLA, Sutherland J, et al . Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. CMAJ 2017; 189: 1379-85. pmid:29133539 PubMed  
  27. Perry JJ, Stiell IG, Sivilotti MLA, et al. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343: d4277. BMJ (DOI)  
  28. Claassen J, Bernardini GL, Kreiter K, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke 2001; 32: 2012-20. Stroke  
  29. Lawton MT, Vates GE. Subarachnoid hemorrhage. N Engl J Med 2017; 377: 257-66. doi:10.1056/NEJMcp1605827 DOI  
  30. Baharoglu MI, Germans MR, Rinkel GJ, et al. Antifibrinolytic therapy for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2013 Aug 30;8:CD001245. doi: 10.1002/14651858.CD001245.pub2. The Cochrane Library  
  31. Whitfield PC, Kirkpatrick PJ. Timing of surgery for aneurysmal subarachnoid hemorrhage. Cochrane Database Syst Rev 2001; 2. The Cochrane Library  
  32. Lundar T. Behandling av intrakraniale aneurismer. Tidsskr Nor Lægeforen 2005; 125: 2162. PubMed  
  33. Sandell T, Isaksen J, Bajic R et al. Behandling av intrakraniale aneurismer Tidsskr Nor Lægeforen 2005; 125: 2188-91. PubMed  
  34. International Subarachnoid Aneurysm Trial (ISAT) Colloborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267-74. PubMed  
  35. Mayer SA, Kreiter KT, Copeland D, et al. Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology 2002; 59: 1750-8. Neurology  
  36. Hillman J, Fridriksson S, Nilsson O et al. Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachoid hemorrhage: a prospective randomized trial. J Neurosurg 2002; 97: 771-8. PubMed  
  37. Pedersen HK, Bakke SJ, Hald JK et al. CTA in patients with subarachnoid haemorrhage. Acta Radiologica 2001; 42: 43-9. PubMed  
  38. Nieuwkamp DJ, Setz LE, Algra A, et al. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex and region: a meta-analysis. Lancet Neurol 2009; 8: 635-42. pmid:19501022 PubMed  
  39. Wik KE, Lindegaard K-F, Brunborg B et al. Livet etter akutt subaraknoidalblødning Tidsskr Nor Lægeforen 2005; 125: 152-4. PubMed  
  40. Wik KE, Lindegaard K-F, Brunborg B, Bjørk IT, Ruland C. Livet etter akutt hjernehinneblødning. Tidsskr Nor Lægeforen 2005; 125: 152-4. PubMed  
  41. Nome T, Bakke SJ, Nakstad PH. MR angiography in the follow-up of coiled cerebral aneurysms treated with Guglielmi detachable coils. Acta Radiol 2002; 43: 10-4. PubMed  
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Bo Norrving, professor och överläkare, Neurologkliniken, Skånes universitetssjukhus (Medibas)
  • Tor Ingebrigtsen, dr. med., overlege, Nevrokirurgisk avdeling, Universitetssykehuset i Nord-Norge, Tromsø
  • Bent Indredavik, dr. med., seksjonsoverlege, seksjon for hjerneslag, Medisinsk avdeling, St. Olavs Hospital, Trondheim
  • Jørgen Isaksen, assistentlege Nevrokirurgisk avdeling, Universitetssykehuset i Nord-Norge, Tromsø