Definition of SAH】Subarachnoid hemorrhage is a type of stroke in which blood flows into the subarachnoid space after the rupture of blood vessels at the base of the brain or on the surface of the brain causing corresponding clinical symptoms, also known as primary subarachnoid hemorrhage, abbreviated as SAH in English.
Causes of SAH] ① intracranial aneurysm, the most common, accounting for about 75%; ② cerebrovascular malformation, accounting for about 5-10%; ③ smog (Moyamoya disease); ④ others, entrapment aneurysm, vasculitis, cerebral atherosclerosis, blood disorders, etc. Shaobing Wang, Department of Neurosurgery, Hubei Provincial Hospital of Integrative Medicine
Therefore cases of typical subarachnoid hemorrhage should first be considered for the presence of ruptured intracranial aneurysm bleeding
Risk factors] The main risk factors for ruptured intracranial aneurysm hemorrhage include smoking, hypertension, excessive alcohol consumption, previous history of aneurysm rupture, multiple aneurysms, etc. Among them, smokers have larger aneurysms and more frequent multiple aneurysms compared with nonsmokers.
Clinical manifestations] 1. age: all ages and both sexes can develop, young adults are common, more females than males; 2. onset: sudden onset, headache occurring in seconds or minutes is the common mode of onset; 3. performance: severe headache, “burst-like” or “electric shock-like” headache. The headache is “burst-like” or “electric shock-like”, while the neck is straight, often accompanied by nausea, vomiting, convulsions, unconsciousness, and even respiratory and cardiac arrest in severe cases, and about 10-15% of patients die before reaching the hospital.
[Complications] 1. rehemorrhage: the morbidity and mortality rate of rehemorrhage is 50%, the risk of rehemorrhage is greatest 24 hours after onset, and the risk of rehemorrhage is higher in all 4 weeks. 2. cerebral vasospasm: it starts in 3~5 days, peaks in 5~14 days, and gradually decreases after 2~4 weeks. 3. hydrocephalus: about 15%~20% of patients may develop acute obstructive hydrocephalus, and some patients develop traffic hydrocephalus later. 4. Other: seizures, etc.
Image examination data]
Figure 1: CT image of subarachnoid hemorrhage
Figure 2: DSA image of posterior communicating artery aneurysm
Figure 3: DSA image showing anterior communicating aneurysm
Figure 4: Schematic diagram of aneurysm craniotomy clamping
Figure 5: Schematic diagram of aneurysm embolization surgery