Ostermayer: Retarget anticoagulation reversal link to existing page Anticoagulant reversal for life-threatening bleeds

2026-04-28T04:38:03Z

Retarget anticoagulation reversal link to existing page Anticoagulant reversal for life-threatening bleeds

← Older revision		Revision as of 04:38, 28 April 2026
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	*ABCs, [[c-spine]] precautions, full trauma evaluation		*ABCs, [[c-spine]] precautions, full trauma evaluation
	*Avoid hypoxia (SpO₂ ≥90%) and hypotension (SBP ≥90–110 mmHg by age) — secondary insults worsen outcomes<ref name="btf2017">Carney N, et al. Guidelines for the Management of Severe Traumatic Brain Injury, 4th ed. ''Neurosurgery''. 2017;80(1):6-15. PMID 27654000</ref>		*Avoid hypoxia (SpO₂ ≥90%) and hypotension (SBP ≥90–110 mmHg by age) — secondary insults worsen outcomes<ref name="btf2017">Carney N, et al. Guidelines for the Management of Severe Traumatic Brain Injury, 4th ed. ''Neurosurgery''. 2017;80(1):6-15. PMID 27654000</ref>
	*Reverse anticoagulation/antiplatelet agents per [[anticoagulation reversal]] protocols		*Reverse anticoagulation/antiplatelet agents per [[Anticoagulant reversal for life-threatening bleeds\|anticoagulation reversal]] protocols
	*Treat elevated [[intracranial pressure]] if signs of herniation: head of bed 30°, hyperosmolar therapy ([[hypertonic saline]] or [[mannitol]]), brief hyperventilation as bridge		*Treat elevated [[intracranial pressure]] if signs of herniation: head of bed 30°, hyperosmolar therapy ([[hypertonic saline]] or [[mannitol]]), brief hyperventilation as bridge
	*Seizure: treat with benzodiazepines acutely; [[levetiracetam]] for early post-traumatic seizure prophylaxis in moderate-severe TBI		*Seizure: treat with benzodiazepines acutely; [[levetiracetam]] for early post-traumatic seizure prophylaxis in moderate-severe TBI

Ostermayer: Remove non-existent Category:Neurosurgery (Trauma category already present)

2026-04-28T04:22:46Z

Remove non-existent Category:Neurosurgery (Trauma category already present)

← Older revision		Revision as of 04:22, 28 April 2026
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	[[Category:Trauma]]		[[Category:Trauma]]
	[[Category:Neurology]]		[[Category:Neurology]]
	~~[[Category:Neurosurgery]]~~
	[[Category:Critical Care]]		[[Category:Critical Care]]

Ostermayer: Create Traumatic SAH page (split from Subarachnoid hemorrhage); trauma-specific content with mBIG template

2026-04-28T04:18:54Z

Create Traumatic SAH page (split from Subarachnoid hemorrhage); trauma-specific content with mBIG template

New page

''Subarachnoid hemorrhage caused by blunt or penetrating head trauma. For non-traumatic SAH, see [[Aneurysmal subarachnoid hemorrhage]].''

==Background==
*Bleeding into the subarachnoid space due to traumatic disruption of pial/cortical vessels
*'''Most common CT finding after moderate-to-severe [[traumatic brain injury]]''' and a frequent finding in [[mild traumatic brain injury]] with a positive head CT
*Mechanism: tearing of small subarachnoid/cortical vessels from acceleration–deceleration or direct impact; rarely from traumatic dissection or aneurysm rupture provoked by trauma
*Often co-exists with other intracranial injuries: [[cerebral contusion]], [[traumatic intracerebral hemorrhage]], [[subdural hemorrhage]], [[epidural hemorrhage]], [[diffuse axonal injury]]
*Isolated traumatic SAH (tSAH) in [[mild traumatic brain injury|mild TBI]] generally has a benign course with low risk of neurosurgical intervention<ref name="borczuk2013">Borczuk P, et al. Patients with traumatic subarachnoid hemorrhage are at low risk for deterioration or neurosurgical intervention. ''J Trauma Acute Care Surg''. 2013;74(6):1504-1509. PMID 23694880</ref>

==Clinical Features==
*History of head trauma (witnessed or suspected)
*Headache, nausea, vomiting
*Altered mental status proportional to severity of underlying TBI ([[GCS]] often 13–15 in isolated tSAH)
*Scalp injury, skull tenderness, signs of [[basilar skull fracture]] (Battle sign, raccoon eyes, hemotympanum, CSF oto-/rhinorrhea)
*Focal neurologic deficits if associated parenchymal injury
*Post-traumatic seizure
*'''Distinguishing from aneurysmal SAH''': trauma history is key; if mechanism is unclear or syncope/collapse preceded the fall, consider [[aneurysmal subarachnoid hemorrhage]] as the inciting event

==Differential Diagnosis==
{{Head trauma DDX}}
*[[Aneurysmal subarachnoid hemorrhage]] (consider if collapse preceded the fall)
*[[Traumatic intracerebral hemorrhage]]
*[[Subdural hemorrhage]]
*[[Epidural hemorrhage]]
*[[Cerebral contusion]]
*[[Diffuse axonal injury]]
*[[Concussion]]

==Evaluation==
===Non-Contrast CT Head===
*'''First-line imaging''' for any patient meeting trauma head CT criteria ([[Canadian CT Head Rule]], [[New Orleans Criteria]], [[NEXUS II]], [[PECARN]] for pediatrics)
*Hyperdense blood in sulci, fissures, or cisterns; convexity SAH most common in trauma (vs basal cisterns in aneurysmal SAH)
*Evaluate for associated injuries: contusion, ICH, SDH, EDH, skull fracture, midline shift, herniation

===CT Angiography===
*Consider if pattern is atypical for trauma (e.g., predominantly basal cistern blood), unclear mechanism, or to exclude blunt cerebrovascular injury per institutional protocol

===Labs===
*CBC, BMP, coagulation studies (PT/INR, PTT)
*Type and screen if surgical intervention possible
*Consider ethanol/toxicology if altered

==Management==
===ED Management===
*ABCs, [[c-spine]] precautions, full trauma evaluation
*Avoid hypoxia (SpO₂ ≥90%) and hypotension (SBP ≥90–110 mmHg by age) — secondary insults worsen outcomes<ref name="btf2017">Carney N, et al. Guidelines for the Management of Severe Traumatic Brain Injury, 4th ed. ''Neurosurgery''. 2017;80(1):6-15. PMID 27654000</ref>
*Reverse anticoagulation/antiplatelet agents per [[anticoagulation reversal]] protocols
*Treat elevated [[intracranial pressure]] if signs of herniation: head of bed 30°, hyperosmolar therapy ([[hypertonic saline]] or [[mannitol]]), brief hyperventilation as bridge
*Seizure: treat with benzodiazepines acutely; [[levetiracetam]] for early post-traumatic seizure prophylaxis in moderate-severe TBI
*Analgesia: acetaminophen; avoid NSAIDs/ketorolac
*'''Nimodipine is NOT routinely indicated for traumatic SAH''' (in contrast to aneurysmal SAH)
*Tranexamic acid within 3 hours of injury for moderate TBI (GCS 9–15) per [[CRASH-3]]<ref name="crash3">CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. ''Lancet''. 2019;394(10210):1713-1723. PMID 31623894</ref>

===Disposition===
*Neurosurgical consultation for any traumatic intracranial hemorrhage at non-trauma centers; transfer per local protocol
*Repeat head CT generally at 6 hours (or sooner if neurologic change) for traumatic ICH
*Risk-stratification of mild TBI with isolated tSAH may use the '''[[Modified brain injury guideline (mBIG)]]''' to guide neurosurgical consultation, repeat imaging, and admission level

{{MBig}}

==See Also==
*[[Subarachnoid hemorrhage]]
*[[Aneurysmal subarachnoid hemorrhage]]
*[[Head trauma]]
*[[Traumatic brain injury]]
*[[Mild traumatic brain injury]]
*[[Traumatic intracerebral hemorrhage]]
*[[Subdural hemorrhage]]
*[[Epidural hemorrhage]]
*[[Cerebral contusion]]
*[[Diffuse axonal injury]]
*[[Modified brain injury guideline (mBIG)]]

==References==
<references/>

[[Category:Trauma]]
[[Category:Neurology]]
[[Category:Neurosurgery]]
[[Category:Critical Care]]

Traumatic subarachnoid hemorrhage - Revision history

Ostermayer: Retarget anticoagulation reversal link to existing page Anticoagulant reversal for life-threatening bleeds

Ostermayer: Remove non-existent Category:Neurosurgery (Trauma category already present)

Ostermayer: Create Traumatic SAH page (split from Subarachnoid hemorrhage); trauma-specific content with mBIG template