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Subaraknoidalblødning: Prognosen

SAB er en hyperakutt og farlig tilstand med opptil 15 prosent dødelighet i akutt fase. Dersom man ikke blir operert, er det stor fare for nye blødninger fra det samme aneurismet. Slike andregangsblødninger er enda farligere, med en dødelighet helt opp mot 50 prosent. Derfor er tidlig behandling viktig for å forebygge nye blødninger. 

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Det er også økt risiko for at blodtilførselen til deler av hjernen kan bli nedsatt de første 1-2 ukene etter en subaraknoidalblødning, og forårsake hjerneslag . Dette forebygges best ved nøye kontroll, behandling og overvåkning i intensivavdelingen. 

Pasienter som blir operert, og som ikke har fått hjerneskade før operasjonen eller de første to ukene etterpå, har en god prognose. I en norsk studie anga cirka halvparten av dem som overlevde, at de hadde god eller svært god livskvalitet.

Dette dokumentet er basert på det profesjonelle dokumentet Subaraknoidalblødning . Referanselisten for dette dokumentet vises nedenfor

  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
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