II. Background

  1. See Subarachnoid Hemorrhage
  2. This page refers only to Traumatic Subarachnoid Hemorrhage (non-aneurysmal)

III. Mechanism

  1. See Head Injury
  2. Fall with Head Injury in the elderly
  3. Motor Vehicle Accident in younger patients

IV. Imaging

V. Management: General

VI. Management: Small Traumatic Subarachnoid Hemorrhage

  1. Background
    1. Small Traumatic Subarachnoid Hemorrhage (SAH) is a common finding on CT Head after Closed Head Injury
    2. Unlike Aneurysmal SAH, small Traumatic SAH is much less likely to have neurologic decompensation
      1. Cerebral Vasoconstriction is much less likely in Traumatic SAH (contrast with Aneurysmal SAH)
  2. Monitoring
    1. Serial Neurologic Exams
    2. Repeat CT Head in 6 hours after first imaging CT Head
      1. Indicated for early discharge or as needed for Neurologic Exam changes on exam
  3. Indications to consider early discharge after repeat Head CT (at 6 hours)
    1. Glasgow Coma Scale (GCS) 15
    2. No Anticoagulation or antiplatelet agents
    3. Safe home social situation (e.g. not homeless, available for close interval follow-up)
    4. Small peripheral Subarachnoid Hemorrhage consistent with Traumatic SAH
      1. Central SAH is much more suggestive of Aneurysmal SAH
  4. References
    1. Marcolini and Swaminathan in Swadron (2023) EM:Rap 23(5): 13-4

VII. References

  1. Swaminathan and Marcolini in Herbert (2017) EM:Rap 17(6):17-18
  2. Burgess and Stowens (2014) Crit Dec Emerg Med 28(5): 2-13
  3. Levy (2015) Crit Dec Emerg Med 29(4): 10-4
  4. Bederson (2009) Stroke 40(3): 994-1025 [PubMed]
  5. Cohen-Gadol (2013) Am Fam Physician 88(7): 451-6 [PubMed]
  6. van Gijn (2007) Lancet 369(9558): 306-18 [PubMed]

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