Subarachnoid hemorrhage clinical manifestations

Written by Wang Li Bing
Intensive Care Medicine Department
Updated on September 09, 2024
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When a subarachnoid hemorrhage occurs, patients can experience varying degrees of headache, usually unbearable, accompanied by nausea and vomiting. Projectile vomiting indicates high intracranial pressure in the patient. Hours after the second subarachnoid hemorrhage, signs of meningeal irritation can appear, generally presenting positively, such as neck stiffness, headache, vomiting, etc. The third issue involves varying degrees of consciousness and mental disorders in patients, and some may even display symptoms of epilepsy. Therefore, with the appearance of the above clinical symptoms, patients should actively seek treatment from a neurologist for further management.

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Written by Zhang Hui
Neurology
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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.

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Written by Li Ai Ping
Neurology
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What to do with a headache from subarachnoid hemorrhage?

Subarachnoid hemorrhage, the most typical symptom of which is headache, often manifests as a sudden severe throbbing or bursting pain. The pain may be localized to a specific area of the head, or it may affect the entire head or neck, and it generally persists continuously. If such a headache occurs, one should first rest in bed, avoid emotional excitement and exerting great force, such as coughing, shouting loudly, or straining during bowel movements, etc. If the pain is unbearable, one can ask a doctor for appropriate pain relief medication. However, if the headache suddenly worsens, one should be cautious of the condition deteriorating and should seek medical advice to investigate the cause of the worsening headache. One should not blindly request medication for pain relief, as it may mask the underlying condition.

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Written by Zhang Hui
Neurology
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Complications of subarachnoid hemorrhage

Subarachnoid hemorrhage is a relatively serious condition. Most patients suffer from this due to the rupture of an aneurysm, while others may have arteriovenous malformations. This disease is associated with complications, with common ones including the following. First, there are acute complications of subarachnoid hemorrhage. Patients usually experience severe pain and vomiting again after their condition stabilizes, and the mortality rate significantly increases. The second complication is cerebral vasospasm, which typically peaks between three days and two weeks. Cerebral vasospasm can easily lead to vascular occlusion and the subsequent formation of cerebral thrombosis. The third type includes acute or subacute hydrocephalus. Additionally, seizures and electrolyte disorders may also occur as complications.

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Written by Wei Shi Liang
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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.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Pre-symptoms of subarachnoid hemorrhage

Before a subarachnoid hemorrhage, patients generally do not exhibit obvious symptoms. However, if a patient suddenly experiences severe headaches, nausea, vomiting, and other discomforts, subarachnoid hemorrhage should be suspected. The patient should promptly seek attention and complete a cranial CT scan. If the diagnosis of subarachnoid hemorrhage is confirmed, measures should be taken to dehydrate the patient and reduce intracranial pressure. If the patient has a significant amount of intracranial bleeding, surgical treatment should be considered to remove intracranial hematomas and other proactive managements, while dynamically observing changes in the patient's consciousness and pupils.