Page 97 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

However, other distributions of wall motion abnormalities may occur as well. These WMA are not related to the perfusion territory of a single coronary artery. The abnormalities are reversible after 1-2 weeks and prognosis is reported to be excellent. Although reports and studies on stress cardiomyopathy are rapidly expanding, not much is known about this fascinating phenomenon. It is difficult to design reliable studies and estimate the sample size in a heterogeneous patient group with unknown prevalence and incidence of the disease that is subject of study. Most reports on stress cardiomyopathy are case reports or case series. Reports on incidence, predisposing factors, pathophysiology, prognosis or treatment are scarce and equivocal. Because aSAH is a disease with a poor outcome that is often complicated by cardiac abnormalities, we decided to use aSAH as a model for acute sympathetic stress and study the incidence, clinical characteristics and impact on outcome of stress cardiomyopathy after aSAH.
Aneurysmal subarachnoid hemorrhage
Aneurysmal subarachnoid hemorrhage is caused by rupture of a saccular aneurysm usually in the circle of Willis. Blood enters the subarachnoid (spider web) space under high pressure. The subarachnoid space is the anatomic space between the dura mater and the pia mater (figure 2).
Figure 2: Schematic drawing of the layers of the skull and subarachnoid space. From Wikipedia, usage under creative commons license (CMC)
Veins Superior sagittal sinus
General Discussion
Arachnoid mater Subarachnoid space
Pia mater
Arachnoid trabeculae
Cerebral vein
Bone
Dura mater
Subdural space
Arachnoid
granulation villi 7
Longitudinal fissure Cerebral cortex
This space is filled with trabeculae, giving it its spider web appearance, and contains cerebrospinal fluid. Typical symptoms of aSAH are acute onset “thunderclap” headache described as the worst headache patients have ever experienced. In the
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