Subarachnoid hemorrhage causes increased intracranial pressure.

Written by Zhang Jin Chao
Neurosurgery
Updated on February 20, 2025
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Patients with subarachnoid hemorrhage often have very high intracranial pressure. The main reason for the rise in intracranial pressure is that after the hemorrhage, the bloody cerebrospinal fluid usually stimulates nerves and blood vessels within the brain, which can lead to edema, such as vascular edema and neural edema, thereby gradually increasing the intracranial pressure. Sometimes, and relatively infrequently, the increase in cranial pressure is not significant. However, if the volume of subarachnoid hemorrhage is very large, the intracranial pressure can rise substantially, leading to symptoms like severe nausea, vomiting, and headache, and in severe cases, there can be significant disturbances in consciousness. Additionally, patients with subarachnoid hemorrhage may sometimes experience obstructive or communicating hydrocephalus, which can also lead to increased cranial pressure.

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Written by Tang Bo
Neurology
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Does subarachnoid hemorrhage require surgery?

Whether subarachnoid hemorrhage requires surgery depends on the specific circumstances, as there are many causes of subarachnoid hemorrhage, commonly caused by aneurysms. Therefore, the decision to perform surgery is based on the size of the aneurysm and the amount of bleeding, as well as the patient’s overall condition to determine if they can tolerate surgery. Additionally, some subarachnoid hemorrhages may be caused by arteriovenous malformations or other reasons. The decision whether to opt for surgery or conservative treatment also depends on the amount of bleeding and the patient's symptoms, and the risk involved is relatively high.

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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.)

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Written by Wang Li Bing
Intensive Care Medicine Department
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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.

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Written by Liu Yan Hao
Neurology
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Subarachnoid hemorrhage is caused by what?

The most common cause of subarachnoid hemorrhage is the rupture of a cerebral aneurysm. The subarachnoid space is located on the surface of the brain, surrounded by three layers of meninges: from inner to outer, they are the pia mater, arachnoid mater, and dura mater. The space between the pia mater and arachnoid mater is known as the subarachnoid space. Following the rupture of a cerebral aneurysm, blood enters this subarachnoid space, leading to hemorrhage. Subarachnoid hemorrhage is a critical condition in internal medicine, with a relatively high mortality rate. The most common cause is a cerebral aneurysm, and patients who have suffered a subarachnoid hemorrhage should undergo brain MRI and vascular imaging to check for the presence of cerebral aneurysms or vascular abnormalities. If a cerebral aneurysm is present, it needs to be treated promptly. Typical interventions include placing a coiling spring to close off the aneurysm, preventing it from rupturing and thus averting a secondary subarachnoid hemorrhage, which has a mortality rate as high as 50%. Another common cause of subarachnoid hemorrhage is brain trauma, which is also a frequent cause of this condition.

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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.