What are the symptoms of subarachnoid hemorrhage?

Subarachnoid hemorrhage occurs suddenly. If the patient is emotionally excited, furious or coughing, it may become a trigger, leading to symptoms such as headache, nausea, vomiting and cold sweats all over the body, which must be taken seriously.

1. Bleeding symptoms: The onset of the disease is sudden. Most patients have triggers such as emotional excitement, exertion, defecation, and coughing before the onset of the disease. The patient suddenly suffered from severe headache, nausea and vomiting, pale complexion, and cold sweat all over the body. Half of the patients may experience mental symptoms, such as irritability, confusion, and disorientation. The most common symptom is transient unconsciousness, and in severe cases, the patient may fall into a coma or even die from brain herniation. 20% of patients may experience convulsions after bleeding.

2. Some patients do not experience dizziness, neck or back pain, or lower limb pain. Signs of meningeal irritation (neck resistance, positive Krashen, Brugner, and Lasego signs) are obvious and usually appear within 1 to 2 days after subarachnoid hemorrhage. After bleeding, most patients receive symptomatic treatment and their condition gradually stabilizes, their consciousness and vital signs improve, and their symptoms of meningeal irritation are alleviated.

3. After the first rupture and bleeding of an intracranial aneurysm, if not treated promptly, some patients may bleed again or a third time. About one-third of patients with this disease die from rebleeding, usually within six weeks. There are also cases where the tumor may rupture and bleed again months or even decades later.

3. Cranial nerve damage: Unilateral oculomotor nerve paralysis is common, accounting for 6% to 20%, indicating an ipsilateral internal carotid artery-posterior communicating artery aneurysm or posterior cerebral artery aneurysm.

5. Hemiplegia: About 20% of patients with this disease develop hemiplegia and mild hemiplegia before or after bleeding. This is caused by lesions or bleeding compressing the motor cortex and its conduction bundles.

6. Visual field disorders: Blood in the subarachnoid space can extend along the optic nerve sheath. Fundus examination shows subvital hemorrhage in 25% of patients. This bleeding may occur within 1 hour after onset, which is strong evidence for diagnosing subarachnoid hemorrhage. When the amount of bleeding is too large, blood may seep into the vitreous body and cause visual impairment. Papilledema may be seen in 10% to 20% of patients. Involvement of the optic chiasm, optic tracts or optic radiations will produce bitemporal hemianopsia or homonymous hemianopsia.