Differentiation between subarachnoid hemorrhage and cerebral hemorrhage

Written by Zhang Hui
Neurology
Updated on September 16, 2024
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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 Zhang Hui
Neurology
1min 11sec home-news-image

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 Zhang Hui
Neurology
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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.

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Written by Shen Jiang Chao
Radiology
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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.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Subarachnoid hemorrhage examination methods

Subarachnoid hemorrhage is also relatively common in clinical practice. Patients may experience severe headaches, nausea, and projectile vomiting. The clinical signs generally include positive meningeal irritation signs, typically presenting with neck stiffness, Kernig's sign, and Brudzinski's sign all being positive. Clinically, the diagnosis can be confirmed mainly through cranial CT scans. If conditions permit, lumbar puncture can be performed to ascertain the nature of the cerebrospinal fluid and the intracranial pressure, etc. After a subarachnoid hemorrhage occurs, patients should be admitted to the neurology department for active treatment, and typically receive dehydration therapy to reduce intracranial pressure and neuroprotection among other symptomatic treatments.

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Written by Tang Li Li
Neurology
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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.)