Mediterranean Journal of Emergency Medicine & Acute Care

Introduction: Subarachnoid hemorrhage (SAH) is a life-threatening condition characterized by bleeding into the subarachnoid space. Most data regarding non-traumatic SAH is from the U.S. and Europe with a paucity of studies from the Middle East. Therefore, this study aims at assessing the characteristics of SAH patients and describing associated factors and outcomes in a sample of SAH patients presenting to an emergency department in a regional tertiary-care medical center in Lebanon.

Method: A  retrospective medical chart review was conducted on all patients presenting to the emergency department with non-traumatic SAH from September 2009 to September 2016 using hospital discharge diagnosis (ICD-9 code 430); descriptive analyses were carried out to map patients’ characteristics, clinical presentation and potential factors.

Results: Within the span of seven years, 94 patients presented with non-traumatic SAH with a mean age of 55 years and a predominance of female gender (62.8%). Most patients presented with headache (79.8%). Almost all patients underwent non-contrast computed tomography scan of the brain in the emergency department (95.7%), 95.6% of which had a positive finding. Etiology of SAH was mostly due to an aneurysm (66.0%), 75.8% of which were in the anterior cerebral circulation, followed by unknown causes (28.7%). In-hospital complications were found in 21.3% of patients and in-hospital mortality was 6.4%.

Conclusion: Subarachnoid hemorrhage is a debilitating medical condition which has not previously been described in the Lebanese population. Incidence and outcomes of SAH in this study are comparable to other regions including Europe and the United States.

Loxosceles genus represents a wide number of species including the brown recluse spider. This spider is known worldwide for causing serious injuries resulting from its bite. The diagnosis of brown recluse spider bite is challenging as the injury clinically resembles other conditions and cannot be confirmed unless the spider was observed. We present a case of a 46-year-old male who presented to the emergency department with sudden onset of two painful punctate lesions. We discuss the clinical presentation, investigation and approach; additionally, we briefly highlight the main points with regards to presentation, diagnosis and management of this condition.

Spiders are eight-legged arthropods that belong tothe arachnids class and are found on every continentexcept Antarctica.1 As of 2020, there are over 48000recognized species of spiders with more than 5000in the Mediterranean area. Out of these, only twospiders, the Latrodectus tredecimguttatus and theLoxosceles rufescens are of medical significance in theMediterranean area.1 Although most spider bites arebenign; however, severe reactions and life-threateningenvenomation do occur.