It is a clinical syndrome caused by the rupture of blood vessels at the base or surface of the brain, leading to blood entering the subarachnoid space. Common causes include intracranial aneurysms, cerebral arteriovenous malformations, hypertensive cerebral arteriosclerosis, and moyamoya disease.

bubble_chart Diagnosis

1. Medical History and Symptoms:

Common triggers include emotional agitation and excessive exertion. Some patients have a history of headache episodes. Sudden onset of severe headache and vomiting often occurs during activity, with a few cases presenting psychiatric symptoms, epileptic seizures, dizziness, vertigo, and pain in the neck, back, and lower limbs.

2. Physical Examination Findings:

Most show no obvious focal neurological signs, primarily manifesting as meningeal irritation signs. A minority may exhibit mild paralysis or sensory impairment in a limb, or oculomotor nerve palsy on one side. Fundoscopic examination may reveal subhyaloid hemorrhage, and some cases show papilledema. Occasionally, symptoms of the posterior cranial nerves or brainstem may be observed. In rare severe cases, patients may rapidly progress to deep unconsciousness, presenting with decerebrate rigidity. In cases of cerebrovascular malformation, a vascular murmur may sometimes be auscultated locally.

3. Auxiliary Examinations:

1. Lumbar puncture reveals increased cerebrospinal fluid pressure with uniform bloody appearance;

2. Cranial CT shows blood in the subarachnoid space and cisterns. Intravenous contrast enhancement may partially reveal malformed blood vessels, allowing assessment for intracerebral hematoma, vasospasm, and obstructive hydrocephalus;

4. Differential Diagnosis:

Distinguish from conditions such as cerebral hemorrhage and central nervous system infections that may also present with meningeal irritation signs.

bubble_chart Treatment Measures

1. Absolute bed rest for at least 4-6 weeks, avoiding agitation, excessive exertion, coughing, and defecation to prevent rebleeding.

2. Administer sedatives and analgesics (Diazepam 5mg 3 times/day, Rotundine 60mg 3 times/day). Use 20% mannitol, furosemide, etc., to reduce intracranial pressure.

3. High-dose hemostatic agents: 6-aminocaproic acid 8-12g, once/day, gradually reducing the dose after 7-10 days, with a treatment course of 3 weeks (use with caution in patients with renal impairment).

4. Prevent cerebrovascular spasms with calcium ion antagonists: Nimotop injection 100mg administered slowly via a microsyringe, or oral Nimodipine tablets 20mg 3 times/day for 21 days.

5. Lumbar puncture to drain bloody cerebrospinal fluid, 15-20ml each time, once every 3-4 days.

6. Perform selective surgical treatment based on cerebral angiography findings. {|105|}