Spontaneous subarachnoid hemorrhage, typical manifestations to know

Spontaneous subarachnoid hemorrhage is a symptom of many diseases. Common symptoms of this disease include headache. Most patients will experience sudden headache, nausea and vomiting, mental and consciousness disorders, and some people will also experience epilepsy.

(1) Headache: It occurs in 80% to 95% of patients. It is sudden and presents as splitting pain, which spreads over the whole head or forehead, occipital area, and then extends to the neck, shoulders, waist, back and lower limbs. The headache caused by rupture of anterior aneurysm of the Willis circle may be limited to the forehead and orbit on the same side. Flexing the neck, moving the head, Valsalva test, sound and light can aggravate the pain. Lying quietly in bed can relieve the pain. There are often triggers before the onset of headache: strenuous exercise, breath-holding or sexual intercourse, which account for about 20% of the incidence.

(2) Nausea and vomiting, pale complexion, cold sweats. About 3/4 of patients experience headaches, nausea and vomiting after the onset of the disease.

(3) Impaired consciousness: This occurs in more than half of the patients, who may experience temporary confusion or even coma. 17% of the patients are already in a coma when they seek medical attention. A small number of patients may have no changes in consciousness, but may have symptoms such as photophobia, apathy, fear of loud noises and vibrations.

(4) Psychiatric symptoms: manifested as delirium, stupor, disorientation, confabulation and dementia.

(5) Epilepsy: occurs in 20% of patients.

(6) Physical signs:

① Meningeal irritation: about 1/4 of patients may have neck pain and neck stiffness, which may appear within a few hours to 6 days after onset, but most often lasts for 1 to 2 days. Kernig's sign is more common than neck stiffness.

②Unilateral or bilateral pyramidal tract disease.

③ Fundus hemorrhage: manifested as subhyaloid flake hemorrhage, more common in rupture of anterior communicating artery aneurysm. Due to increased ICP and blood clot compression of the optic nerve sheath, central retinal vein hemorrhage is caused. This sign is of special significance because it still exists after the cerebrospinal fluid returns to normal. It is one of the important bases for diagnosing subarachnoid hemorrhage. Optic disc edema is rare, but once it occurs, it indicates an intracranial space-occupying lesion. Due to intraocular hemorrhage, the patient's vision often decreases.

④ Focal signs, which are usually absent, may include unilateral oculomotor nerve paralysis, monoplegia or hemiplegia, aphasia, sensory impairment, visual field loss, etc. They may indicate the primary disease and location or be caused by hematoma or cerebral vasospasm.