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Subarachnoid hemorrhage
Subarachnoid hemorrhage is a condition.
Subarachnoid hemorrhage refers to the rupture of blood vessels due to lesions at the base or on the surface of the brain, with blood directly flowing into the subarachnoid space, causing a clinical syndrome. This is different from cerebral hemorrhage, which refers to bleeding within the brain tissue itself, not into the subarachnoid space. So, what is the subarachnoid space? The human brain is covered by three layers of membranes: the pia mater, arachnoid, and dura mater. The subarachnoid space is the area between the pia mater and the arachnoid membrane, named as such. When there is a rupture in cerebral vascular malformations or cerebral aneurysms, blood flows directly into the subarachnoid space rather than causing bleeding in the brain tissue. Subarachnoid hemorrhage is considered a very serious medical condition with a very high mortality rate. Its main symptoms include severe headache, increased intracranial pressure, nausea, and projectile vomiting. If it is a second occurrence of subarachnoid hemorrhage, the mortality rate can reach up to 50%. A third occurrence of subarachnoid hemorrhage almost certainly results in death.
The difference between cerebral hemorrhage and subarachnoid hemorrhage
There is a significant difference between cerebral hemorrhage and subarachnoid hemorrhage. For subarachnoid hemorrhage, the specific causes are mainly divided into two types. The first cause is due to trauma, violent strikes, car accidents, or falls from heights, leading to localized vascular rupture and extensive subarachnoid hemorrhage. It generally presents as obvious high-density shadows in the ventricular system or cisterns. The occurrence of subarachnoid hemorrhage often leads to symptoms such as headache, dizziness, neck stiffness, and positive meningeal irritation signs. The other situation is spontaneous subarachnoid hemorrhage, most often due to intracranial aneurysms or arteriovenous malformations. Cerebral hemorrhage is primarily due to hypertensive cerebral hemorrhage, which is more likely to occur, mostly seen in the bilateral basal ganglia, presenting as localized high-density shadows.
Symptoms and signs of subarachnoid hemorrhage
The typical symptoms of subarachnoid hemorrhage include headache, vomiting, and sudden severe pain, accompanied by vomiting, pale complexion, and whole-body cold sweats. Additionally, there may be disturbances in consciousness and psychiatric symptoms. Most patients do not experience disturbances in consciousness, but may exhibit restlessness and agitation. Severe cases can show varying degrees of clouded consciousness, and even coma, with a few instances displaying seizures and psychiatric symptoms. Furthermore, signs of meningeal irritation are also present, particularly common and pronounced in young and middle-aged patients, characterized by neck stiffness, headaches, and vomiting.
Complications of subarachnoid hemorrhage
Subarachnoid hemorrhage is a very dangerous disease primarily caused by the rupture of the meninges or blood vessels at the base of the skull, leading to blood entering the subarachnoid space. Clinically, the most common cause is an aneurysm, but it can also occur with some arteriovenous malformations. Subarachnoid hemorrhage can cause severe headaches, nausea, vomiting, and other complications, with severe cases leading to coma. Common complications of subarachnoid hemorrhage include, firstly, rebleeding. The probability of rebleeding is very high, and if it occurs, the disability and mortality rates of the patient significantly increase. Secondly, cerebral vasospasm, which is an important complication that can lead to severe cerebral thrombosis due to intense constriction of the blood vessels. Thirdly, it can cause secondary hyponatremia, leading to electrolyte imbalance. Additionally, complications of subarachnoid hemorrhage include increased intracranial pressure, hydrocephalus, and more.
Subarachnoid hemorrhage headache causes
Subarachnoid hemorrhage commonly presents with clinical symptoms such as headache, reflex vomiting, and even consciousness disorders, seizures, etc. The main reasons for headaches caused by subarachnoid hemorrhage are, firstly, increased intracranial pressure, and secondly, impaired absorption of cerebrospinal fluid, leading to excessive accumulation in the subarachnoid space causing headaches. Additionally, blood entering the subarachnoid space can stimulate the meninges and toxic substances can also cause headaches. Therefore, patients should go to the hospital for a complete cranial CT examination and consult with the Department of Neurology or Neurosurgery.
Does subarachnoid hemorrhage have a genetic component?
Subarachnoid hemorrhage, this disease does not have a significant genetic tendency, so there is no need to worry excessively. The main cause of the bleeding is the rupture of an aneurysm, which is due to abnormal blood vessel development resulting in fusiform aneurysms that rupture and bleed under certain conditions. Additionally, there are other causes of subarachnoid hemorrhage, such as long-term smoking which can cause arterial disease, some arteriovenous malformations are also prone to rupture and bleed, and some traumatic injuries can also lead to subarachnoid hemorrhage; these are not hereditary. Subarachnoid hemorrhage is a rather dangerous condition, so it is essential to control risk factors, properly manage blood pressure, and absolutely avoid smoking. If severe headaches, nausea, and vomiting occur, it is crucial to be highly vigilant and seek medical attention at a hospital immediately.
Differentiation between subarachnoid hemorrhage and cerebral hemorrhage
Subarachnoid hemorrhage and cerebral hemorrhage, though both involve bleeding, have different mechanisms of onset. The first distinction is that cerebral hemorrhage is generally caused by hypertension. Hypertension leads to hyaline degeneration and fibrinoid necrosis of arteries, resulting in bleeding. In contrast, the most common cause of subarachnoid hemorrhage is an aneurysm, which may be related to factors such as smoking and congenital developmental abnormalities. In terms of clinical presentation, cerebral hemorrhage has a sudden onset, with symptoms of headache, nausea, vomiting, but also includes impairments in language functions, and signs of neurological deficits such as limb paralysis. Subarachnoid hemorrhage, on the other hand, typically involves very severe pain, usually without manifestations such as limb paralysis. Furthermore, from a radiological perspective on CT imaging, cerebral hemorrhage is mainly located in the brain parenchyma, while subarachnoid hemorrhage mainly indicates that the site of bleeding is in the subarachnoid space.
Clinical manifestations of subarachnoid hemorrhage
The main clinical manifestations of subarachnoid hemorrhage are sudden severe headache, accompanied by nausea and vomiting, with positive signs of meningeal irritation. If such symptoms occur, it is urgent to seek medical attention and perform a cranial CT scan. If the CT shows a high-density shadow in the subarachnoid space, it can be diagnosed as subarachnoid hemorrhage, and the patient should be treated in neurology or neurosurgery for active management. Clinically, conservative medication treatment is generally adopted, paying attention to changes in the patient's consciousness and pupils, and surgical treatment may be considered if necessary.
Subarachnoid hemorrhage nursing rounds
Subarachnoid hemorrhage is a rather dangerous disease. Patients may experience significant symptoms such as headache, nausea, vomiting, and irritability. There can also be complications related to the nervous system. Besides medical and surgical treatment, nursing care is equally crucial. Key aspects to focus on during nursing rounds include: First, fully assess the patient's consciousness to see if they are alert or have slipped into a coma; second, observe the pupils to check if they are symmetrical and how they react to light; third, examine if there is any noticeable stiffness in the neck or signs of meningeal irritation; additionally, look at the pathological reflexes of the lower limbs; also, observe if the patient's mood is notably irritable; finally, monitor if the patient exhibits complications such as fever, cough, or expectoration, and provide the corresponding treatment.
What to pay attention to during the recovery period of subarachnoid hemorrhage?
Patients with subarachnoid hemorrhage generally have aneurysms or arteriovenous malformations as the cause. After onset, the main symptom is usually headache, with positive meningeal irritation signs found during examination, but no signs of neurological function deficit. Therefore, during the recovery phase, patients generally do not show positive neurological signs and have good limb mobility. It is only necessary to take precautions against the cause of the disease. For instance, if the patient's cerebral aneurysm has not been surgically treated, there could be a risk of rebleeding. Patients should minimize physical activity, rest in bed as much as possible, and avoid aneurysm rupture. Regular blood pressure control is also essential. If the cause has already been addressed, there are not many precautions needed. Additionally, long-term administration of nimodipine is necessary to prevent delayed cerebral vasospasm, generally recommended for a period of four to six months. (Medication should be used under the guidance of a doctor based on specific conditions.)