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Subaraknoidalblödning

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Definition:
Akut blödning från stora och medelstora intrakraniella artärer i subaraknoidalrummet mellan hjärnans innersta hinnor, araknoidea och pia mater (utanför hjärnvävnaden). I knappt 80 % av fallen är orsaken ruptur av ett intrakraniellt aneurysm.
Förekomst:
Det inträffar cirka 1000 fall per år i Sverige (cirka 10/100 000/år).
Symtom:
Typiskt är plötslig debut av intensiv huvudvärk som når maximal intensitet inom några sekunder. Oftast följer nackstelhet, illamående och kräkningar, medvetslöshet, krampanfall, yrsel och ljusskygghet.
Kliniska fynd:
Vid undersökning:nackstelhet, nedsatt medvetandegrad, eventuellt medvetslöshet, fokala neurologiska bortfall.
Diagnostik:
Akut inläggning vid misstanke om diagnosen. Diagnostik med DT hjärna.
Behandling:
Kirurgisk behandling, endoskopisk eller öppen. Symtomatisk behandling för att förebygga sekundär ischemi eller andra komplikationer.
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  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet

Tidigare sakkunniga

  • Bo Norrving, professor och överläkare, Neurologkliniken, Skånes universitetssjukhus