People who are easily agitated and constipated should be alert to this serious disease when they have severe headaches!

Author: Huang Yining, Chief Physician, Peking University First Hospital

Reviewer: Xing Yan, Chief Physician of Aviation General Hospital

There are three layers of membranes on the surface of the brain, namely the dura mater, arachnoid mater and pia mater. Between the arachnoid mater and pia mater, there is a potential cavity called the subarachnoid space.

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In the subarachnoid space, there are some loose tissues like spider webs, which wrap many blood vessels. If the blood vessels in this place are broken, the blood can circulate and spread throughout the brain, so subarachnoid hemorrhage is a very dangerous disease.

1. What are the common causes of subarachnoid hemorrhage?

People of different ages have different causes of disease, but the most common one is aneurysm. Aneurysm is a thinning of the blood vessel wall of the artery, which bulges out like a bubble. This aneurysm can rupture and bleed under the induction of some external factors.

Relevant statistics show that more than half of spontaneous subarachnoid hemorrhages are caused by aneurysms.

The second common cause is vascular malformation, because malformed blood vessels are also prone to rupture. There are many blood vessels in the subarachnoid space. When a blood vessel ruptures, blood will flow into the subarachnoid space, so vascular malformation is also a very common cause.

The third common cause is amyloid angiopathy. Amyloid angiopathy actually means that the blood vessels in the subarachnoid space become brittle like lime and starch. This cause cannot be ignored in subarachnoid hemorrhage in the elderly.

Of course, there are many other reasons, such as the use of anticoagulants, aneurysms caused by infection, etc., which may also cause subarachnoid hemorrhage.

For young people, strenuous activities or falls that cause blood vessel tears and lead to aortic dissection, etc. These are common causes of subarachnoid hemorrhage in young people.

2. What factors are likely to induce subarachnoid hemorrhage?

Once there is a foundation of vascular disease, the blood vessel walls become weaker, and blood vessel rupture is likely to occur under the induction of certain factors.

The most common cause is excitement. For example, if you suddenly have a severe headache during an argument, it may be because of excitement that subarachnoid hemorrhage is induced.

Some patients are even very happy when they are ready to be discharged from the hospital after being cured of certain diseases, but out of sheer joy comes sorrow, and suddenly a blood vessel ruptures, leading to subarachnoid hemorrhage. So excitement is the most common cause.

Another common cause is increased abdominal pressure. For example, straining during bowel movements, especially when constipated, can easily cause blood vessels to rupture.

Many patients suddenly develop severe headaches when they exert force in the shower or on the toilet. They go to the hospital for examination and find that they have induced subarachnoid hemorrhage.

Of course, there are many other causes, such as a sudden increase in blood pressure, a sudden change in heart rate, etc. In general, it is the sudden increase in blood vessel pressure that causes the blood vessels to rupture, but its basis is that there are vascular disease factors in it first.

3. What are the characteristics of headache caused by subarachnoid hemorrhage?

Headache is the main sign of subarachnoid hemorrhage, but we cannot say that headache means subarachnoid hemorrhage as soon as bleeding occurs. We can grasp several characteristics to identify it early.

First, severe headache. Patients often complain that the headache is very severe and they have never experienced such a severe headache before. The patient may mention what he was doing at the time when he suddenly had such a severe headache.

Second, the pain is usually felt at the back of the neck, because this is the most common location for aneurysms to rupture.

Third, the neck becomes stiff. For patients with subarachnoid hemorrhage, if they lower their heads, their chins cannot touch their sternum, or they can touch their sternum, but the pain will be more severe. For normal young people, it is easy for the chins to touch the sternum.

If the patient's pain has the above characteristics, especially if it is accompanied by double vision, that is, seeing one thing as two things, there is a 70% to 80% probability of subarachnoid hemorrhage.

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Therefore, if you experience severe headaches at the back of your neck, accompanied by a stiff neck and double vision, you must go to the hospital for a check-up in time to see if it is caused by subarachnoid hemorrhage.

4. How is subarachnoid hemorrhage generally treated?

First, stabilize the patient's vital signs. For example, patients who vomit violently are prone to aspiration of vomitus. Once aspirated into the trachea, the patient cannot breathe. In addition, due to severe pain stimulation, the patient's blood pressure and heart rhythm are prone to abnormalities, so it is important to stabilize the patient's vital signs. This is the most important thing.

Second, sedation. Some patients are in so much pain that they dare not move, and some patients will cry and roll over because of the pain. Patients crying and not cooperating are also a risk factor for aggravating or causing rebleeding. Therefore, in this case, analgesia and sedation should be given to relieve the pain and calm the patient down. Such patients often have a better prognosis.

Third, remove risk factors. For example, patients who are taking anticoagulants should stop taking them immediately and should not continue to take them.

Fourth, the aneurysm can be ligated or blocked through minimally invasive surgery to prevent the subarachnoid hemorrhage from worsening and causing complications.

Another thing is to prevent complications, such as vasospasm. Because there are many blood vessels in the subarachnoid space, under normal circumstances, these blood vessels are soaked in cerebrospinal fluid. But at this time, blood is mixed in the cerebrospinal fluid, so these blood vessels are equivalent to soaking in the blood. Once the blood is stimulated, the blood vessels are prone to spasm, so this situation must be actively prevented.

In short, the treatment of subarachnoid hemorrhage is a comprehensive treatment plan, and the appropriate treatment method should be selected according to the patient's different conditions.