Subarachnoid hemorrhage nursing rounds

Written by Zhang Hui
Neurology
Updated on September 12, 2024
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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 Liu Yan Hao
Neurology
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Subarachnoid hemorrhage is a condition.

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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Written by Wei Shi Liang
Intensive Care Unit
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Symptoms and signs of subarachnoid hemorrhage

The typical symptoms of subarachnoid hemorrhage include headache, vomiting, and sudden severe pain, accompanied by vomiting, pale complexion, and whole-body cold sweats. Additionally, there may be disturbances in consciousness and psychiatric symptoms. Most patients do not experience disturbances in consciousness, but may exhibit restlessness and agitation. Severe cases can show varying degrees of clouded consciousness, and even coma, with a few instances displaying seizures and psychiatric symptoms. Furthermore, signs of meningeal irritation are also present, particularly common and pronounced in young and middle-aged patients, characterized by neck stiffness, headaches, and vomiting.

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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 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 Zhang Hui
Neurology
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Does subarachnoid hemorrhage require surgery?

Subarachnoid hemorrhage is a rather dangerous disease with very high mortality and disability rates. It mainly manifests as sudden severe headaches, nausea, and vomiting, and complications such as bleeding, cerebral vasospasm, and electrolyte disorders can occur. The most common cause of subarachnoid hemorrhage is due to the rupture of an aneurysm. Therefore, it is generally advocated that patients with subarachnoid hemorrhage undergo surgery as soon as possible. The surgical method mainly involves local anesthesia, and a complete cerebral angiography is performed to check for the presence of an aneurysm. If an aneurysm is present, an interventional embolization can be performed, which causes less trauma and generally has a better prognosis. If there is a large amount of bleeding and the patient's life is in danger, a craniotomy may also be necessary. Thus, patients with subarachnoid hemorrhage need to undergo surgical treatment.