Concept and clinical characteristics of subarachnoid hemorrhage

What is subarachnoid hemorrhage?

Subarachnoid hemorrhage refers to the rupture and hemorrhage of blood vessels on the surface of the brain, and the blood flows into the subarachnoid space. There are generally two kinds of etiologies. The most common cause of the disease after the age of 40 is intracranial aneurysm rupture and hemorrhage; Most cases before the age of 30 are caused by the rupture of congenital cerebrovascular malformations. Premonitory symptoms may occasionally occur before the attack. The most common symptom is generalized headache, followed by headache confined to a certain part, inflexible eye movement, neck and back pain, sleepiness and other symptoms.

Clinical characteristics of patients with subarachnoid hemorrhage

The onset is sudden and often without warning, but there may be incentives such as overwork, drinking, and emotional agitation. Severe headache is explosive and knife cut. The pain is mostly in the posterior occipital and neck, sometimes radiating to the forehead, temples and around the eyes.

When the head is lowered, the pain is aggravated, and the neck activity is limited and inflexible. Headache is often accompanied by severe and frequent vomiting, which can be jet like, and some mental symptoms can appear, such as feeling relaxed and comfortable, talking nonsense, seeing imagined scenes that do not actually appear, and hearing sounds that do not actually appear (vision and hearing). Most patients also have stiff neck, irregular breathing, slow pulse, back pain, low back pain, urinary retention due to difficulty or short time.

Severe cases will go into coma in a short time. Subarachnoid hemorrhage generally has no limb paralysis, but it can also appear mild monoplegia or hemiplegia, usually recovers quickly, and occasionally complicated with seizures. With the improvement of the condition, the blood in the cerebrospinal fluid is absorbed, and the above clinical symptoms can gradually recover, but there may be a moderate increase in body temperature, which generally does not exceed a week. There are no sequelae after recovery, but it is easy to relapse.

Cerebral vasospasm secondary to subarachnoid hemorrhage

Patients with subarachnoid hemorrhage usually have a relatively stable condition within 4-14 days after the hemorrhage, and then suddenly have headache, nausea, vomiting, hemiplegia, aphasia and other symptoms, as well as convulsions and loss of consciousness, which can last for 7-21 days. This situation is caused by cerebral vasospasm secondary to subarachnoid hemorrhage. The mechanism of its occurrence is still unclear. Some people believe that it is caused by a substance called oxyhemoglobin produced by the dissolution of red blood cells after subarachnoid hemorrhage. It should be noted that in case of the above situations, the brain CT should be immediately reviewed, or the cerebrospinal fluid should be taken through lumbar puncture, to exclude the possibility of repeated bleeding.

How to handle

In case of clinical symptoms of subarachnoid hemorrhage, the patient should be kept absolutely quiet and try to avoid unnecessary moving. Once confirmed, stay in bed for 3-4 weeks, and use various analgesics and sedatives. The methods of reducing intracranial pressure and hemostasis are the same as those of cerebral hemorrhage. If the headache is serious and cannot be alleviated with general analgesics, 5-30ml of cerebrospinal fluid can be released by lumbar puncture. In recent years, craniocerebral surgery has advocated that after the condition is stable, cerebral angiography should be performed within 3-4 weeks, and those with aneurysms or cerebral vascular malformations should be surgically removed, and those with hematomas should be cleared.

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