Subarachnoid hemorrhage: Early evaluation and optimization of management

A subarachnoid hemorrhage (SAH) is a life-threatening disease that was first described in the 18th century, but it took until the early 20th century until the term "spontaneous subarachnoid hemorrhage" was introduced by the English neurologist Sir Charles P. Symonds. Nowadays, the term spontaneous SAH describes the presence of blood in the subarachnoid space that is not the result of a trauma.
In approximately 85% of cases a SAH is caused by a rupture of an aneurysm on one of the intracranial arteries and this is called an aneurysmal SAH (aSAH). In 15% of all SAH patients no aneurysm is visualized on initial vascular imaging investigations, which classifies these patients into the group of non-aneurysmal SAH.
Not only the initial hemorrhage, but also rebleeds and complications related to the hemorrhage affect the course of the disease and outcome. Therefore, multiple factors need to be addressed to improve the course of the disease and patients’ outcome. Early diagnosis and treatment of SAH patients with the goal to reduce rebleeds might contribute to this improvement.
As this thesis encompasses both aSAH and non-aneurysmal SAH patients, it is split into two parts for a separate evaluation of both patient groups. The first aim of this thesis is to gain better insight into the rebleed risk in the early phase after aSAH and to examine options that can reduce the risk for a rebleed.
The second aim is to assess whether routine MR-imaging of the spinal axis is useful in non-aneurysmal SAH patients to identify a treatable cause of the hemorrhage.