History of Aneurysmal Spontaneous Subarachnoid Hemorrhage
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When persons in good health are suddenly seized with pains in the head, and straightway are laid down speechless, and breathe with stertor, they die in seven days, unless fever come on
—Hippocrates 460–37 BC, Aphorisms on Apoplexy1
Since Hippocrates’ dramatic description of the clinical features in a patient, the authors and many others believed to have experienced subarachnoid hemorrhage over 2400 years ago; this illness has remained a mystery up until the 19th century. The review describes the evolution of our understanding of subarachnoid hemorrhage and its treatment originating in first civilizations up to this very day.
Ancient Egypt and Roman times
First descriptions of an arterial aneurysm date back as early as 3000 years BC.2 Imhotep (2725 BC), the founder of ancient Egyptian medicine, is believed to be an author of a paragraph found in the Ebers Papyrus on the treatment of arterial aneurysms using cautery:
This is a vessel swelling, a disorder I will treat. It is the vessels that cause it. It originates from an injury upon the vessel. Then thou shalt apply to it treatment with the knife; this [the knife] is heated in fire; the bleeding will not be considerable2
The progress of our understanding of arterial aneurysms as a cause of subarachnoid hemorrhage was virtually nonexistent for many years due to religious superstitions and reliance of external bodily examination. It was not until 2 millennia later when first pathophysiological mechanisms were recorded. Ephesian physician Flaenius Rufus (117 BC), who trained in Alexandria, suggested that arterial dilatation may occur as a result of trauma.2 Several hundred years later, Greek physician Galen of Pergamon (AD 129–210) coined the term aneurysm (Greek aneurysma, a widening; from anu, across; and eurys, broad) and recognized 2 distinct entities of true and false arterial aneurysms:
An artery having become …