Complications of subarachnoid hemorrhage

Written by Zhang Hui

Neurology

Updated on September 27, 2024

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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.

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Written by Liu Yan Hao

Neurology

1min 30sec

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Subarachnoid hemorrhage drainage surgery

Subarachnoid hemorrhage drainage, also known as cerebrospinal fluid replacement surgery, often occurs due to the rupture of cerebral aneurysms. The blood clots enter the subarachnoid space causing severe headaches, increased intracranial pressure, nausea, vomiting, and other symptoms. It is essential to drain the blood clots as early as possible to achieve effective treatment results. The subarachnoid space is a gap between the pia mater and arachnoid mater, which are two of the three membranes covering the brain and spinal cord—the innermost layer being the pia mater, followed by the arachnoid and the outermost dura mater. Normally, the subarachnoid space contains cerebrospinal fluid that is continuously circulating. Hence, in patients with subarachnoid hemorrhage, performing a lumbar puncture can drain the bloody cerebrospinal fluid. During this procedure, a puncture is made in the lumbar region to drain the bloody cerebrospinal fluid, followed by the injection of an equal volume of saline solution. This facilitates the replacement of the blood clots in the subarachnoid space with saline solution. Conducting this procedure once daily, continuously for three to five days, can significantly alleviate the symptoms of subarachnoid hemorrhage. Essentially, this process is also known as cerebrospinal fluid puncture or cerebrospinal fluid replacement surgery.

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Written by Wang Li Bing

Intensive Care Medicine Department

52sec

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Subarachnoid hemorrhage should go to which department?

Subarachnoid hemorrhage is also relatively common in clinical settings. Its symptoms primarily include severe headaches, reflex vomiting, possible consciousness disturbances, and even seizures. Following the occurrence of subarachnoid hemorrhage, a cranial CT scan can be used for a definitive diagnosis. Patients typically seek treatment in neurology or neurosurgery departments. After admission to a neurology ward, DSA (Digital Subtraction Angiography) can be conducted to accurately locate the bleeding site, and interventional embolization treatments may be considered. If the patient has a large volume of subarachnoid hemorrhage, neurosurgery might be considered for the removal of intracranial hematomas or decompressive craniectomy, among other procedures.

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Written by Zhang Jin Chao

Neurosurgery

46sec

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Is it normal to have a fever with subarachnoid hemorrhage?

It is normal for patients with subarachnoid hemorrhage to develop a fever, but this must be assessed in conjunction with the patient’s body temperature and overall condition. Sometimes, the amount of bleeding in the subarachnoid space is small and may cause mild fever, mainly due to the irritation of the nerves by bloody cerebrospinal fluid. In other cases, when there is a lot of bleeding, it may cause high fever, possibly central fever, which requires specific measures to reduce the body temperature, such as pharmacotherapy, applying ice packs, or using hypothermia therapy devices. Additionally, some patients develop a fever three to five days after the subarachnoid hemorrhage, which might indicate a secondary infection, such as lung or urinary tract infections, necessitating anti-infection treatment.

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Written by Wang Li Bing

Intensive Care Medicine Department

45sec

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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.

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Written by Shen Jiang Chao

Radiology

52sec

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subarachnoid hemorrhage CT manifestations

Subarachnoid hemorrhage often occurs spontaneously and due to trauma. Spontaneous subarachnoid hemorrhages are usually caused by the rupture of an aneurysm. They have relatively obvious manifestations on CT, appearing as increased columnar strip densities in areas like the suprasellar cistern, quadrigeminal cistern, cerebellar tent, falx cerebri, and lateral fissure pools, as well as strip-like high density shadows within the cerebral sulci and gyri. If the subarachnoid hemorrhage is traumatic, the CT manifestations are generally mild, potentially only showing local fuzziness of the cerebral septum. At the same time, there may also be brain contusion-laceration injuries, such as extradural hematoma, subdural hematoma, and skull fractures.