Subarachnoid Hemorrhage CT Imaging Manifestations

Written by Shen Jiang Chao
Radiology
Updated on February 20, 2025
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Subarachnoid hemorrhage is caused by the rupture of cerebral blood vessels due to various reasons, allowing blood to flow into the subarachnoid space. Common causes include trauma and rupture of congenital aneurysms. Subarachnoid hemorrhage caused by the rupture of congenital aneurysms typically presents on a CT scan with high-density appearances at the base of the skull in the brain pools, especially widespread columnar high-density appearances in the suprasellar cistern, lateral fissure cistern, anterior interhemispheric fissure, and around the circumferential pool. If the subarachnoid hemorrhage is due to trauma, the abnormalities are more localized, generally appearing in the brain pool or cerebral sulcus on the side of injury with high-density appearances, and may also be accompanied by hematomas within the ventricles or bleeding in other locations.

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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.

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Written by Li Hu Chen
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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 Tang Bo
Neurology
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Is subarachnoid hemorrhage considered a minor injury?

Subarachnoid hemorrhage depends on the amount of bleeding and the location to determine the severity of the condition. It can be life-threatening in severe cases. If symptoms such as headache and severe vomiting occur, the possibility of subarachnoid hemorrhage should be considered. Initially, a cranial CT scan should be conducted to confirm the diagnosis. Further investigations should include cranial MRI or CTA vascular imaging, preferably CTA, to determine whether there is rupture bleeding caused by an aneurysm. In such cases, it is necessary to consider whether emergency surgery is required, based on the amount of bleeding and the condition of the blood vessels, and the possibility of an aneurysm to guide further treatment.

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Written by Zhang Jin Chao
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Is it normal to have a fever with subarachnoid hemorrhage?

It is normal for patients with subarachnoid hemorrhage to develop a fever, but this must be assessed in conjunction with the patient’s body temperature and overall condition. Sometimes, the amount of bleeding in the subarachnoid space is small and may cause mild fever, mainly due to the irritation of the nerves by bloody cerebrospinal fluid. In other cases, when there is a lot of bleeding, it may cause high fever, possibly central fever, which requires specific measures to reduce the body temperature, such as pharmacotherapy, applying ice packs, or using hypothermia therapy devices. Additionally, some patients develop a fever three to five days after the subarachnoid hemorrhage, which might indicate a secondary infection, such as lung or urinary tract infections, necessitating anti-infection treatment.

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Written by Chen Yu Fei
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The difference between cerebral hemorrhage and subarachnoid hemorrhage

There is a significant difference between cerebral hemorrhage and subarachnoid hemorrhage. For subarachnoid hemorrhage, the specific causes are mainly divided into two types. The first cause is due to trauma, violent strikes, car accidents, or falls from heights, leading to localized vascular rupture and extensive subarachnoid hemorrhage. It generally presents as obvious high-density shadows in the ventricular system or cisterns. The occurrence of subarachnoid hemorrhage often leads to symptoms such as headache, dizziness, neck stiffness, and positive meningeal irritation signs. The other situation is spontaneous subarachnoid hemorrhage, most often due to intracranial aneurysms or arteriovenous malformations. Cerebral hemorrhage is primarily due to hypertensive cerebral hemorrhage, which is more likely to occur, mostly seen in the bilateral basal ganglia, presenting as localized high-density shadows.