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Abstract Spontaneous subarachnoid hemorrhage is a bleeding into the subarachnoid space without trauma. Aneurysms are the underlying cause in 80% of the cases. Among other causes are arteriovenous malformations, anticoagulation, vasculitis and brain tumor. Spontaneous subarachnoid hemorrhage is a serious disease where up to half of the patients die. Of those who survive, only half return to work and many have a reduced quality of life. The three major complications of subarachnoid hemorrhage are cerebral vasospasm, hydrocephalus and re-bleeding. Sodium abnormalities which occur quite frequently can also be added to this list and are prevalent amongst neurosurgical patients which can in themselves lead to decrease conscious levels, seizures and systemic disturbance seizures. Transcranial Doppler (TCD) is commonly used to detect vasospasm noninvasively and determine which patients should be further evaluated by digital subtraction angiography (DSA), but transcranial Doppler can identify vasospasm with only 67% specificity compared with digital subtraction angiography. The computed tomography (CT) protocol for patients with suspected vasospasm includes a noncontrast CT (NCT) of the brain, computed tomography angiography (CTA), 2-level perfusion computed tomography (PCT) series, and contrast-enhanced CT of the brain. |