Does subarachnoid hemorrhage require surgery?

Written by Zhang Hui
Neurology
Updated on September 09, 2024
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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.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Subarachnoid hemorrhage clinical manifestations

When a subarachnoid hemorrhage occurs, patients can experience varying degrees of headache, usually unbearable, accompanied by nausea and vomiting. Projectile vomiting indicates high intracranial pressure in the patient. Hours after the second subarachnoid hemorrhage, signs of meningeal irritation can appear, generally presenting positively, such as neck stiffness, headache, vomiting, etc. The third issue involves varying degrees of consciousness and mental disorders in patients, and some may even display symptoms of epilepsy. Therefore, with the appearance of the above clinical symptoms, patients should actively seek treatment from a neurologist for further management.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Pre-symptoms of subarachnoid hemorrhage

Before a subarachnoid hemorrhage, patients generally do not exhibit obvious symptoms. However, if a patient suddenly experiences severe headaches, nausea, vomiting, and other discomforts, subarachnoid hemorrhage should be suspected. The patient should promptly seek attention and complete a cranial CT scan. If the diagnosis of subarachnoid hemorrhage is confirmed, measures should be taken to dehydrate the patient and reduce intracranial pressure. If the patient has a significant amount of intracranial bleeding, surgical treatment should be considered to remove intracranial hematomas and other proactive managements, while dynamically observing changes in the patient's consciousness and pupils.

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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 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 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.