Hemorragia subaracnoidea: epidemiologÃa, etiologÃa, fisiopatologÃa y diagnóstico
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OBJETIVO: Revisar la literatura para seleccionar los aspectos más relevantes y avanzados referentes a la epidemiologÃa, etiologÃa, fisiopatologÃa y diagnóstico de la hemorragia subaracnoidea (HSA).
DESARROLLO: La HSA constituye un desafÃo diagnóstico e implica intervenciones complejas, sofisticadas, multidisciplinarias y raramente rutinarias.La sospecha clÃnica de HSA radica en la aparición de cefalea súbita severa con pico en minutos y que persiste más de una hora. El paciente con sospecha de HSA debe ser remitido de forma urgente a un centro hospitalario que disponga al menos de equipo de TC de cráneo, servicio de neurocirugÃa y cuidados intensivos especializados. El primer estudio neurológico a realizar es la TC de cráneo simple, pero su resultado negativo no excluye la HSA. Cuando el resultado de la TC de cráneo es negativo se aconseja la consulta con un especialista en NeurologÃa o NeurocirugÃa para la ejecución de la punción lumbar y la interpretación de los hallazgos. En el protocolo de manejo diagnóstico es esencial un algoritmo estándar para ejecutar con urgencia la angiografÃa estándar y/o la angio–TC acorde al paciente concreto y la disponibilidad de dichas técnicas.
CONCLUSIONES: Se consideran puntos claves de la incidencia, factores de riesgo, causas, mecanismos fisiopatológicos y manejo diagnóstico de la HSA. Las recomendaciones son un resumen de la mejor evidencia disponible para el manejo diagnóstico de este tipo de ictus. No obstante, algunas de las áreas tratadas demandan de investigaciones futuras porque han sido controversiales o han recibido escasa atención.
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