Besides its severe neurological injuries, spontaneous subarachnoid hemorrhage (SAH) commonly causes cardiac complications. These complications could include three different aspects of cardiac diseases, that is, electrocardiographic abnormalities, myocardial injuries, and left ventricular dysfunction. These complications not only may lead to misdiagnosis of SAH as myocardial infarction, but also it may complicate the management of SAH. In this review, we described all cardiac complications during SAH and explained the appropriate monitoring and management of these problems.

This presentation aims to focus on different types of sub arachnoid hemorrhage (diffuse, central and perimesencephalic) with different etiology and their important imaging considerations that are important to know when a radiologist encounter to a case of sub arachnoid hemorrhage.

Background & Aim: Subarachnoid hemorrhage (SAH) caused by the rupture of intracranial aneurysms is a devastating event. One of the standard and major treatments for intracranial aneurysms is craniotomy. The aim of this study was to represent the clinical results of microsurgical clipping approach in management of cerebral aneurysmal SAH in our hospital.Methods & Materials/Patients: This retrospective study was conducted in 162 consecutive patients with SAH undergoing clipping of ruptured aneurysm, between March 2011 and December 2015.The following data of patients were collected from patients’ charts: age, sex, the level of consciousness classified by WFNS grading, pattern of SAH in admitted CT-scan, aneurysm characteristics in CT-angiography or cerebral DSA. Modified Rankin Scale (mRs) was assessed at the discharge time and 6 months later by a postal questionnaire and teleph one interview.Results: In total, 131 patients (81%) had good WFNS (grade 0-3) and 31 (19%) had poor WFNS. A total of 142 (88%) patients had one aneurysm and 20 (12%) had multiple aneurysms. Thirty-seven patients (23%) experienced complication during the surgery. In 162 patients treated by microsurgery, 19 (12%) suffered from infection, 8 (5%) suffered from severe vasospasm, and 21 (13%) ischemia; moreover 15 patients (9%) underwent external ventricular drain (EVD). Twelve patients (7%) had hydrocephalus and 9 (6%) required a ventriculo-peritoneal shunt for the management of hydrocephalus. In total, 110 patients (68%) had good prognosis (mRs 0-2) and 52 (32%) had poor outcome. Out of 131 patients with good WFNS, 84% had good mRs. Twenty five patients (15%) died. The poor outcome was associated with poor WFNS, occurrence of ischemia, and high modified Fisher.Conclusion: This study showed that patients with WFNS grade 0-3 aneurysms could undergo successful clipping microsurgery after SAH.

Background: Cerebral vasospasm is a preventable cause of death and disability in patients who experience aneurysmal subarachnoid hemorrhage (SAH). The aim of this study is to investigate the incidence of cerebral vasospasm following traumatic SAH and its relationship with different brain injuries and severity of trauma.Methods: This cross-sectional study was conducted from October 2006 to March 2007 in department of Neurosurgery in Al-Zahra Hospital. Consecutive head-injured patients who had SAH on the basis of an admission CT scan were prospectively evaluated. The severity of the trauma was evaluated by determining Glasgow Coma Scale (GCS) score on admission. Transcranial Doppler ultrasonography evaluations were performed at least 48 hours after admission and one week thereafter. Vasospasm in the MCA and ACA was defined by mean flow velocity (FV) of more than 120 cm/sec with a Lindegaard index (MVA/ICA FV ratio) higher than 3. Basilar artery vasospasm was defined by FV higher than 85 cm/sec.Results: Seventy seven patients with tSAH were enrolled from whom 13 were excluded. The remaining were 52 (81.2%) men and 12 (18.7%) women, with a mean age of 37.89 years. Trauma was severe in 11 (17.2%), moderate in 13 (20.3%), and mild in 40 (62.5%) patients. From all, 27 patients (42.1%) experienced at least one vasospasm during the study period and MCA vasospasm was the most common in the first and second weeks (55.5%).Conclusions: Traumatic SAH is associated with a high incidence of cerebral vasospasm with a higher probability in patients with severe TBI.