Subarachnoid hemorrhage refers to a 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, accounting for 5% to 10% of all strokes . Intracranial aneurysm is the most common cause, but other causes include nonaneurysmal perimesencephalic hemorrhage, cerebral arteriovenous malformation, abnormal vascular network disease at the base of the brain, dural arteriovenous fistula, dissecting aneurysm, vasculitis, intracranial Venous system thrombosis, connective tissue diseases, intracranial tumors, blood diseases, coagulation disorders. Today I will talk to you about the common complications of subarachnoid hemorrhage:
1. Then Hemorrhage
Re-bleeding is its main acute complication, which refers to reoccurrence of severe headache, vomiting, epileptic seizures, coma or even decerebrate tonic attack and aggravated neck stiffness after the condition is stable , review cerebrospinal fluid is bright red. 20% of patients with aneurysm may rebleed 10 to 14 days after the disease, which doubles the mortality rate. Rebleeding in the acute stage of arteriovenous malformation is rare.
2. Cerebral vasospasm
occurs In the blood vessels surrounded by blood clots in the subarachnoid space, the severity of spasm is related to the amount of bleeding, which can lead to cerebral parenchymal ischemia in more than 1/3 of the cases. The clinical symptoms depend on the spasmed blood vessel, often manifested as fluctuating hemiparesis or aphasia, and sometimes the symptoms are also affected by collateral circulation and cerebral perfusion pressure, which has no positioning value for the carrier artery and is an important cause of death and disability. It began to occur 3 to 5 days after the onset, and the peak period of delayed vasospasm was 5 to 14 days, and gradually disappeared in 2 to 4 weeks.
3. Acute or subacute hydrocephalus
Acute hydrocephalus occurs in 15% to 20% of patients within 1 week of onset, which is caused by blood entering the ventricular system and subarachnoid space to form blood clots that obstruct the cerebrospinal fluid circulation pathway. In mild cases, symptoms such as drowsiness, slow thinking, short-term memory impairment, limited upward vision, abducens nerve palsy, and hyperreflexia of lower extremity tendons may occur. In severe cases, it may cause intracranial hypertension or even brain herniation. Subacute hydrocephalus develops weeks after onset and presents with insidious onset of dementia, abnormal gait, and urinary incontinence.