Objawy okulistyczne w zaburzeniach naczyniowych mózgu.
Część III. Krwotok podpajęczynówkowy
Ocular Manifestation of the Vascular Brain Disorders.
Part III. Subarachnoid Hemorrhage
Iwona Obuchowska, Zofia Mariak
Klinika Okulistyki Uniwersytetu Medycznego w Białymstoku
Kierownik: prof. dr hab. n. med. Zofia Mariak
Summary: Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space, which is found between the arachnoidea and the pia mater. In the majority of cases, approximately 80% the cause of hemorrhage is the brain aneurysm rupture. Classical symptoms of SAH include sudden and severe headache with rapid onset, vomiting, meningal symptoms, and consciousness disturbances. Vegetative symptoms, electrolytic and metabolic disorders can accompany the changes. In outlining symptoms of SAH severity, it is useful to use 5-degree Hund-Hess scale. One of the possible SAH complications are optic disc edema, pre- and intraretinal hemorrhage, and massive bleeding into the vitreous, known as the Terson syndrome. The disorders are connected with sudden increase in intracerebral pressure, which result in the increase in pressure in the subarachnoid space of the optic nerve and in the retinal venous system. SAH diagnosis is made on clinical grounds and medical imaging, which confirm bleeding. The modality of choice is computer tomography of the brain. Therapeutic management with individuals with SAH involves general measures to stabilize the patients, prevention of rebleeding from the same aneurysm (clipping or coil embolization) and prevention of a phenomenon, known as vasospasm. The last one is a serious SAH complication, in which the blood vessels constriction cause ischemic brain injury, referred to as “delayed ischemic”. Triple H therapy (hypertension, hypervolume, hemodilution) is used as a measure to treat vasospasm.
Słowa kluczowe: krwotok podpajęczynówkowy, skala Hunta-Hessa, krwotoki siatkówkowe, zespół Tersona, skurcz naczyniowy.
Keywords: subarachnoid hemorrhage, Hunt-Hess scale, retinal hemorrhage, Terson syndrome, vasospasm.