Sudden severe headaches should alert you to this disease - subarachnoid hemorrhage

Author: Fang Yanbo Department of Neurological Critical Care, The First Affiliated Hospital of Zhengzhou University

Reviewer: Du Ran, deputy chief physician of the Department of Neurological Critical Care, the First Affiliated Hospital of Zhengzhou University

Most people have experienced headaches, but if you have a sudden and severe headache of unknown cause, please be careful, it may be subarachnoid hemorrhage! Subarachnoid hemorrhage is impressive because patients describe it as "the most severe headache in their life". Let's learn about this disease today.

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1. What is subarachnoid hemorrhage?

Speaking of subarachnoid hemorrhage (SAH), everyone may be unfamiliar with it. In fact, it is a type of stroke in which blood flows into the subarachnoid space after a blood vessel ruptures at the base or surface of the brain, causing corresponding clinical symptoms, accounting for 5% to 10% of all strokes. SAH is often accompanied by complex and serious complications, and the mortality rate is high. The MONICA study suggests that the mortality rates 24 hours, 48 ​​hours, 7 days and 28 days after the onset of SAH are 37%, 60%, 75% and 41.7%, respectively. Among SAH patients, those over 60 years old have a higher risk of death than those under 60 years old. The patient's neurological status after the onset of the disease, especially the patient's level of consciousness, is the most important factor in determining the prognosis of SAH. Even if they survive, patients are still prone to residual neurological deficits, which seriously affects their quality of daily life.

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2. How does subarachnoid hemorrhage occur?

1. Causes

The most common cause of subarachnoid hemorrhage is intracranial aneurysm. Other causes include cerebral arteriovenous malformations, abnormal vascular network disease at the base of the brain, dural arteriovenous fistula, dissecting aneurysm, vasculitis, thrombosis of the intracranial venous system, connective tissue disease, intracranial tumors, blood diseases, coagulation disorders and complications of anticoagulant treatment, etc. In some patients, the cause is unknown.

2. High-risk groups

Subarachnoid hemorrhage is more common in people with aneurysms, hypertension, smoking, alcoholism, family history, and people aged 40 to 60.

3. What are the symptoms of subarachnoid hemorrhage?

(1) Headache and vomiting: The most prominent clinical symptom is a sudden severe headache, which is distending or bursting and unbearable. It can be local pain or a full headache. Sometimes the upper neck may also have pain, which persists and cannot be relieved or becomes increasingly severe; accompanied by nausea, vomiting, pale face, and cold sweat all over the body.

(2) Impairment of consciousness and mental symptoms: Most patients do not have impaired consciousness, but may be irritable. Critically ill patients may have varying degrees of unconsciousness or even coma, and a few may experience epileptic seizures and mental symptoms.

(3) Meningeal irritation signs: They are more common and obvious in young and middle-aged patients, manifested as stiff neck, headache, vomiting, etc.

(4) Associated symptoms: with or without focal signs (immobility of the eyes, mild hemiplegia of the limbs, inability to speak, or sensory impairment).

3. What tests can help diagnose subarachnoid hemorrhage?

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1. Head CT

Head CT is the preferred method for diagnosing subarachnoid hemorrhage. The CT results can be used to preliminarily determine or indicate the location of intracranial aneurysms. Dynamic CT examinations can help understand the absorption of bleeding, whether there is rebleeding, secondary cerebral infarction, hydrocephalus and its degree.

2. Cerebral angiography

When conditions permit and the patient's condition permits, whole-brain digital subtraction angiography (DSA) should be performed as soon as possible to determine the presence of an aneurysm and the cause of bleeding, thereby deciding on the treatment method and judging the prognosis.

3. Combined head and neck CT angiography

That is, computerized tomography angiography (CTA) examination, which is mainly used for screening of patients with a family history of aneurysms or precursors to rupture, follow-up of patients with aneurysms, and as an alternative method when DSA cannot be performed in a timely manner. CTA examination is faster and less invasive than DSA, and is especially suitable for critically ill patients.

4. Lumbar puncture

For patients with suspected SAH but negative CT results, further lumbar puncture is required. Colorless and transparent normal cerebrospinal fluid can help rule out SAH that occurred within the last 2 to 3 weeks; uniformly bloody cerebrospinal fluid can support the diagnosis of SAH.

4. What should I do if subarachnoid hemorrhage occurs?

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(1) If you have a sudden severe headache accompanied by vomiting and suspect subarachnoid hemorrhage, you should go to the hospital promptly for treatment and complete relevant examinations.

(2) Closely monitor changes in vital signs and neurological signs, keep the airway open, monitor blood pressure, and maintain stable respiratory and circulatory system functions.

(3) Active drug treatment to prevent and treat rebleeding, reduce intracranial pressure, relieve pain, and prevent and treat complications such as cerebral vasospasm, hydrocephalus, and epilepsy.

(5) Find the cause of bleeding, treat the primary disease, and prevent recurrence. Patients with intracranial aneurysms and arteriovenous malformations can undergo endovascular treatment or neurosurgery after evaluation by a physician.

(6) The patient should stay in bed for 4 to 6 weeks and closely monitor changes in vital signs and nervous system. If any changes occur, inform medical staff in a timely manner.

(7) Avoid exertion, emotional fluctuations, and severe coughing, keep bowel movements open, adopt a high-fiber, high-protein diet, and pay attention to preventing urinary tract infections and lung infections.