Subarachnoid hemorrhage is a condition.

Written by Liu Yan Hao
Neurology
Updated on September 29, 2024
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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.

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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.

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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.

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Subarachnoid hemorrhage nausea and vomiting how to treat

Patients with subarachnoid hemorrhage experiencing nausea and vomiting can still be treated. Firstly, symptomatic treatment should be conducted, which can include using gastric mucosal protectants and antiemetic medications to effectively alleviate symptoms. Additionally, subarachnoid hemorrhage, nausea, and vomiting are often caused by increased intracranial pressure. In such cases, using mannitol or furosemide to dehydrate can reduce intracranial pressure. Once the intracranial pressure decreases, the symptoms of nausea and vomiting can be greatly improved and alleviated. Of course, some patients may also have complications such as hydrocephalus or intracerebral hematoma. In these cases, surgical interventions like craniotomy for hematoma removal or aneurysm clipping may be necessary, which can gradually relieve and improve the symptoms of nausea and vomiting. Beyond symptomatic treatment, it is also necessary to treat the underlying primary disease, addressing causes such as aneurysms or vascular malformations.

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Subarachnoid Hemorrhage CT Imaging Manifestations

Subarachnoid hemorrhage is caused by the rupture of cerebral blood vessels due to various reasons, allowing blood to flow into the subarachnoid space. Common causes include trauma and rupture of congenital aneurysms. Subarachnoid hemorrhage caused by the rupture of congenital aneurysms typically presents on a CT scan with high-density appearances at the base of the skull in the brain pools, especially widespread columnar high-density appearances in the suprasellar cistern, lateral fissure cistern, anterior interhemispheric fissure, and around the circumferential pool. If the subarachnoid hemorrhage is due to trauma, the abnormalities are more localized, generally appearing in the brain pool or cerebral sulcus on the side of injury with high-density appearances, and may also be accompanied by hematomas within the ventricles or bleeding in other locations.

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Written by Liu Yan Hao
Neurology
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How long is the recovery period for subarachnoid hemorrhage?

The recovery period for subarachnoid hemorrhage is four to six weeks, during which absolute bed rest is theoretically required. Subarachnoid hemorrhage is a severe emergency in internal medicine with a very high mortality rate. Common causes of subarachnoid hemorrhage include cerebral vascular malformation, cerebral aneurysm, and rupture of blood vessels into the subarachnoid space, causing various symptoms. The main symptoms include severe headache, increased intracranial pressure, nausea, and vomiting. There are three layers of meninges in the subarachnoid space, consisting of the pia mater, arachnoid mater, and dura mater. Between the pia mater and the arachnoid mater is the subarachnoid space. Following a subarachnoid hemorrhage, a large amount of blood enters the subarachnoid space, leading to increased intracranial pressure, which can cause cerebral edema, brain cell death, and even brain herniation, potentially compressing the respiratory control center and leading to death. Without proper treatment, the mortality rate of a second subarachnoid hemorrhage can reach up to 50%, and for a third subarachnoid hemorrhage, survival is almost impossible with the mortality rate nearly 100%.