Subarachnoid hemorrhage due to intracranial aneurysm When you or your family members experience the following symptoms, you need to be highly alert for spontaneous subarachnoid hemorrhage and seek medical attention as soon as possible: (1) Headache is the most common first symptom, with sudden, severe splitting pain throughout the head or forehead, occipital region, and then extending to the neck, shoulders, waist and back, and lower extremities. (2) Disorders of consciousness: there may be transient confusion to coma, usually not more than 1 hour, but some patients remain in coma until death. (3) Nausea and vomiting, pallor, and cold sweat. About 75% of the patients may have headache, nausea and vomiting after the onset of the disease. (4) Neurological dysfunction mainly occurs depending on the site of the aneurysm. The main manifestations include sudden loss of visual acuity or aggravation of the existing visual impairment; inability to lift the eyelid on the affected side and limitation of eye movement due to articular nerve palsy; diplopia, hemiparesis, aphasia and brainstem symptoms due to abducens nerve palsy. (5) Systemic symptoms: Central hyperthermia, uremia, massive gastrointestinal bleeding, acute pulmonary edema, etc. may occur due to hypothalamic damage caused by subarachnoid hemorrhage. At the same time, the symptoms are often atypical due to the special physique of the elderly and children. The onset of headache in the elderly is generally less manifest and less obvious, but it is often accompanied by severe impairment of consciousness, and stiffness of the neck is common. In children, headache is rare, but when it occurs, it should be taken seriously. In children, it is often associated with systemic pathologies, such as aortic arch stenosis and polycystic kidney. Why does spontaneous subarachnoid hemorrhage occur? Subarachnoid hemorrhage is not exactly a stand-alone disease. The main causes of subarachnoid hemorrhage are: intracranial aneurysms, cerebrovascular malformations, smog, hypertension, atherosclerosis, tumors, and hematologic diseases. As the population of addicts increases, the number of cases of subarachnoid hemorrhage caused by cocaine and other drugs is also on the rise. Ruptured aneurysms account for 75%-80% of patients with subarachnoid hemorrhage. According to statistics, after the first rupture of an aneurysm, the mortality rate is as high as 30%-40%, half of which die within 48 hours after the onset of the disease. 1/3 of surviving cases may experience rebleeding, and the mortality rate of those who experience rebleeding is as high as 70%-80%. Cerebral arteriovenous malformations account for about 10% to 15% of patients with subarachnoid hemorrhage, and the mortality rate of initial hemorrhage is about 10%. Therefore, intracranial aneurysms and cerebral arteriovenous malformations are called “untimely bombs in the human body”. The main risk of subarachnoid hemorrhage is the possibility of rebleeding, cerebral vasospasm and hydrocephalus. Therefore, the first priority for patients with subarachnoid hemorrhage is to identify the cause of the hemorrhage and to treat it aggressively. One-third of patients with spontaneous subarachnoid hemorrhage occur at night during sleep; one-third have no clear trigger; the remaining one-third are associated with a number of triggers, such as emotional stress, defecation, weight bearing, coughing, childbirth, trauma, surgery, and sexual intercourse. How to confirm the diagnosis: To make a definite diagnosis after the above symptoms, you may need to undergo the following tests: 1. Head CT has an accuracy rate of nearly 100% in diagnosing acute SAH, showing increased density in the brain sulcus and brain pool. Among them, CTA is a non-invasive cerebrovascular imaging method, which can be used as a screening tool for the diagnosis of head, neck and intracranial vascular diseases. 2.Digital subtraction angiography (DSA) is an important tool necessary to determine the cause of SAH, and should be regarded as a routine examination for SAH patients. Early cerebral angiography can clarify the size, location, single or multiple aneurysms, the presence of vasospasm, the supply arteries and draining veins of arteriovenous malformations, and the condition of collateral circulation in time. A spinal arteriogram should also be performed for suspected spinal arteriovenous malformations. If necessary, other tests such as lumbar puncture may be required depending on your specific condition. How is it treated? Take the most common cause of intracranial aneurysm as an example. An intracranial aneurysm is a cystic dilatation of the wall of an intracranial blood vessel, and its most prominent clinical manifestation is spontaneous subarachnoid hemorrhage. This disease is life-threatening because it tends to cause rebleeding and therefore must be treated surgically. There are two types of surgical treatment: surgical treatment and neurointerventional radioendovascular treatment. While craniotomy is effective, it is risky, traumatic and damaging to brain tissue, endovascular embolization has become the preferred treatment for intracranial aneurysm because it is minimally invasive, effective and can solve the problems that cannot be solved by craniotomy. Our department has rich experience and domestic first-class technology level in the treatment of intracranial aneurysm.