Differentiation between subarachnoid hemorrhage and cerebral hemorrhage

Written by Zhang Hui
Neurology
Updated on September 16, 2024
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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 Zhang Hui
Neurology
1min 11sec home-news-image

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 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 Zhang Jin Chao
Neurosurgery
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Is there a cure for secondary bleeding in subarachnoid hemorrhage?

This needs to be specifically analyzed based on the patient's condition. In most cases, a second subarachnoid hemorrhage is often very severe and generally considered beyond recovery. The patient is likely to die or, even if their life is saved, they may suffer from serious sequelae. They may remain in a prolonged coma, exist in a vegetative state, or suffer from severe impairments that prevent them from caring for themselves. However, some patients are luckier. With a second or third subarachnoid hemorrhage that is not very severe, if it is recognized early and treated promptly, and if the primary diseases are managed and aneurysms are treated with embolization or craniotomy for clipping, the outcomes can be favorable. In such cases, complete recovery is possible, and the patient can be saved.

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Written by Zhang Hui
Neurology
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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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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.