A Contribution to Clinical studies on some Aspects of Subarachnoid Haemorrhage

Abstract

Several questions and unclarified poirrts concerning subarachnoid bleedings still remain to be solved- including the concept of tle disease itself and its symptoms, aetiology and pathogenesis, as well as those dealing vvith pathologic anatomy and its relation to symptomatology.

On the basis of observations of 35 patients and the data obtained, the follovving conclusions can be drawn:

(i) The concept of subarachnoid haemorrhage, currently interpreted as referring to sporrtaneous haemorrhage only, should cover ali blood effusions of the kind, without regard to causes; consequently, subarachnoid haemorrhage resulting from trauma should also be included here, in so far as it is associated vvith blood-vessels of the brain and not vvith the cerebral substance;

(ii) The age factor has a certain bearing on both aetiologic causes and patologico-anatomical changes. In this respect, two groups are to be distinguished, i.e. Group A- consisting of elderly people with arteriosclerosis as the primary cause, the heamorrhage being initially of an intracerebral character and only subsequerrtly subarachnoidal, and Group B of younger people with a different aet:ology and haemorrhage accomparied vvith meningeal manifestations; 

(iii) The course of tbje disease depends mainly on the aetiology and type of heamorrhage and quantity of effused blood. The haemorrhage due to aneurysm or arteriosclerosis has the shortest course with the worst prognosis and highest death rate;

(iiii) The occurring symptoms differ both subjectively and objectively, depending on the quantity and localisation of the haemorrhage. Their division irrto appoplectic and menningeal groups cannot be maintained because both groups occur in almost ali cases; accordingly, we should rather speak of primary and secondary symptoms. However, the most appropriate division would seem to be into meningeal and cerebral forms, the former comprising the cases of pure subarachnoid haemorrhage and the lateral including also those associated vvith injuries done to the brain;

(iiiii) With reference to the aetiology of subarachnoid haemorrhage, vvhich differs considerably from the cerebral, it is the aneurysms that come first, coupled vvith other arterial processes some of vvhich ae still unknovvn. No less important is the pathogenesis of the disease vvhich, closely associated with aetiology, exercises its influence on the clinical picture, further course and final outcome of these bleedings;

(iiiiii) Various anatomico-pafhological changes likevvise exercise tiheir influence on the origin and occurrence of symptoms vvhose appearance is largely conditioned by 3 factors: the quantity of effused blood, localisation, haemorrhage and its nature. In addition, allovvance must be made for general intracranial dynamics vvhich is also concrened here. It is because of these complicated irrterrelations that subarachgoid bleedings lack the localisation value found in other cerebral processes.