How is subarachnoid hemorrhage treated?

Written by Wei Shi Liang
Intensive Care Unit
Updated on September 07, 2024
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The treatment of subarachnoid hemorrhage primarily aims to prevent rebleeding, vasospasm, hydrocephalus, and other complications, reducing mortality and disability rates. During the acute phase, keep the patient's head in a raised position, lying on their side, and provide dehydration, sedation, and pain relief; absolute bed rest; monitor blood pressure; and when bleeding is significant, undertake ventricular puncture for drainage. Patients with subarachnoid hemorrhage should generally be admitted to the ICU, monitoring vital signs and changes in neurological signs, ensuring airway patency, maintaining stable respiratory and circulatory functions, resting quietly, avoiding emotional agitation, ensuring smooth bowel movements, and for patients with increased intracranial pressure, appropriately restricting fluid intake.

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Written by Wang Li Bing
Intensive Care Medicine Department
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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 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 Hu Chen
Imaging Center
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Subarachnoid hemorrhage MR manifestations

Subarachnoid hemorrhage is typically visible on an MR scan, where blood presence can be detected in the cerebral sulci. MR stands for Magnetic Resonance, and it offers various scanning sequences such as T1, T2, diffusion imaging, and fluid-attenuated inversion recovery (FLAIR). Although it may sound complex, these sequences can show high signals in areas of the brain sulci where normally there should be no distinctive signals or colors. After a subarachnoid hemorrhage, these areas show up as brightly lit on the images. Hence, magnetic resonance imaging is particularly sensitive to even small amounts of subarachnoid hemorrhage, especially noticeable in the diffusion imaging sequences where these bright signals are prominently visible.

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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 Zhang Hui
Neurology
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What is good to eat for subarachnoid hemorrhage?

Subarachnoid hemorrhage is most commonly caused by an aneurysm. Once an aneurysm ruptures, it can lead to blood leaking into the subarachnoid space, causing severe headaches, nausea, vomiting, and other clinical symptoms. The onset is very sudden and the headaches can be extremely intense. It is crucial to treat aggressively and clamp the aneurysm as soon as possible. The diet for patients with subarachnoid hemorrhage should include: First, it is essential to take anti-vasospasm medications, as subarachnoid hemorrhage can easily lead to arterial spasms. Calcium channel blockers should be used to prevent arterial spasms to avoid severe complications. Second, consume foods that aid in bowel movements, such as bananas, apples, and oranges. It is vital for patients with subarachnoid hemorrhage to maintain regular bowel movements, and these foods can help. Third, eat high-quality proteins to strengthen the body and prevent complications. This can include fish, lean meats, beef, and drinking milk.