Subarachnoid space in the context of Intraventricular hemorrhage

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. Symptoms may include a severe headache of rapid onset, vomiting, decreased level of consciousness, fever, weakness, numbness, and sometimes seizures. Neck stiffness or neck pain are also relatively common. In about a quarter of people a small bleed with resolving symptoms occurs within a month of a larger bleed.

SAH may occur as a result of a head injury or spontaneously, usually from a ruptured cerebral aneurysm. Risk factors for spontaneous cases include high blood pressure, smoking, family history, alcoholism, and cocaine use. Generally, the diagnosis can be determined by a CT scan of the head if done within six hours of symptom onset. Occasionally, a lumbar puncture is also required. After confirmation further tests are usually performed to determine the underlying cause.

Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic with or without an opioid into the subarachnoid space. Usually a single-shot dose is administrered through a fine needle, alternatively continuous spinal anaesthesia through a intrathecal catheter can be performed. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true anaesthesia, motor, sensory and autonomic (sympathetic) blockade.Administering analgesics (opioid, alpha2-adrenoreceptor agonist) in the cerebrospinal fluid without a local anaesthetic produces locoregional analgesia: markedly reduced pain sensation (incomplete analgesia), some autonomic blockade (parasympathetic plexi), but no sensory or motor block.Locoregional analgesia, due to mainly the absence of motor and sympathetic block may be preferred over locoregional anaesthesia in some postoperative care settings.The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available (Whitacre, Sprotte, Gertie Marx and others).

Arachnoid granulations (also arachnoid villi, and Pacchionian granulations or bodies) are small outpouchings of the arachnoid mater and subarachnoid space into the dural venous sinuses of the brain. The granulations are thought to mediate the draining of cerebrospinal fluid (CSF) from the subarachnoid space into the venous system.

The largest and most numerous granulations lie along the superior sagittal sinus; they are however present along other dural sinuses as well.

The dural venous sinuses (also called dural sinuses, cerebral sinuses, or cranial sinuses) are venous sinuses (channels) found between the periosteal and meningeal layers of dura mater in the brain. They receive blood from the cerebral veins, and cerebrospinal fluid (CSF) from the subarachnoid space via arachnoid granulations. They mainly empty into the internal jugular vein.Cranial venous sinuses communicate with veins outside the skull through emissary veins. These communications help to keep the pressure of blood in the sinuses constant.

The major dural venous sinuses included the superior sagittal sinus, inferior sagittal sinus, transverse sinus, straight sinus, sigmoid sinus and cavernous sinus. These sinuses play a crucial role in cerebral venous drainage. A dural venous sinus, in human anatomy, is any of the channels of a branching complex sinus network that lies between layers of the dura mater, the outermost covering of the brain, and functions to collect oxygen-depleted blood. Unlike veins, these sinuses possess no muscular coat.

The subarachnoid cisterns are spaces formed by openings in the subarachnoid space, an anatomic space in the meninges of the brain. The space is situated between the two meninges, the arachnoid mater and the pia mater. These cisterns are filled with cerebrospinal fluid (CSF).

Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Examples of these conditions include meningitis and subarachnoid hemorrhage. It may also be used therapeutically in some conditions. Increased intracranial pressure (pressure in the skull) is a contraindication, due to risk of brain matter being compressed and pushed toward the spine. Sometimes, lumbar punctures cannot be performed safely (for example due to a severe bleeding tendency). It is regarded as a safe procedure, but post-dural-puncture headache is a common side effect if a small atraumatic needle is not used.

The procedure is typically performed under local anesthesia using a sterile technique. A hypodermic needle is used to access the subarachnoid space and collect fluid. Fluid may be sent for biochemical, microbiological, and cytological analysis. Using ultrasound to landmark may increase success.