诊断
为了诊断蛛网膜下腔出血，医务人员可能建议：
- CT 扫描。这种影像学检查可以检测脑出血。虽然在操作正确的情况下 CT 扫描是一项非常有效的检查，但如果您的红细胞计数较低（贫血），并且在出血时只有少量失血，扫描可能无法发现出血。医生可能注射造影剂，以更详细地查看您的血管（CT 血管造影）。
- MRI。这种影像学检查也可以检测脑出血。医务人员可能将染色剂注射到血管中，以更详细地查看动脉和静脉（MR 血管造影），并突出显示血流。在 CT 扫描未显示出蛛网膜下腔出血迹象的极少数情况下，这种方法可能显示出相关迹象。
- 脑血管造影。医务人员将一根细长管（导管）插入动脉并穿行至大脑。然后，将染色剂注入脑部血管，以让它们显示在 X 线影像中。医务人员可能建议进行脑血管造影，以获得更详细的图像。如果怀疑是蛛网膜下腔出血，但原因不明确或其他影像学检查未检出，他们也可能建议进行该项检查。如果第一次未显示出动脉瘤，但医务人员认为很可能存在动脉瘤，您可能需要进行第二次脑血管造影。
在一些动脉瘤性蛛网膜下腔出血病例中，初始影像学检查可能无法发现出血。如果首次 CT 扫描检查未显示出血，医生可能建议进行腰椎穿刺。腰椎穿刺是将针头插入下背部，以抽取少量脑脊液（大脑和脊髓周围的液体）。然后检查这些液体中是否有血液，有则可能意味着您存在蛛网膜下腔出血。
治疗
治疗的重点是稳定病情，治疗动脉瘤（如有），并预防并发症。
医务人员会检查您的呼吸、血压和血流。
如果出血是由脑动脉瘤破裂引起，医务人员可能会建议：
- 外科手术。外科医生在头皮上开一个切口，并找到脑动脉瘤。在动脉瘤上放置金属夹，以阻止血液流向动脉瘤。
- 血管内栓塞术。外科医生将导管插入一根动脉中，然后将其引导至大脑中。引导可脱铂丝弹簧圈穿过导管，将其置于动脉瘤中。弹簧圈会填塞动脉瘤，减少流入动脉瘤囊的血液并使血液凝结。已经开发出了各种类型的弹簧圈用于治疗各种动脉瘤。
- 其他血管内治疗。某些动脉瘤可采用血管内栓塞治疗，这种治疗方法使用较新的技术，例如支架辅助或球囊辅助的弹簧圈或血流导向装置。
由于您可能会再次出血，大脑血流不畅，血液中的钠等盐含量偏低，脑内积液过多，或者血糖偏高或偏低，因此务必要预防并发症。药物尼莫地平（Nymalize）已被证明可以减少蛛网膜下腔出血后的脑部循环问题。
脑血管迟发性痉挛是动脉瘤性蛛网膜下腔出血后常见的一种并发症。如果血流量因此下降到一定水平以下，就会导致卒中。当发生脑血管迟发性痉挛时，可以静脉注射药物提高血压或使用药物扩张大脑血管，以防止卒中。
另一种常见的并发症是脑积水，也就是液体在脑腔隙中的积聚。脑积水可以通过在头部（脑室造口导管）或下背部（腰椎引流管）插入引流管来治疗。
有时，需要重复这些医疗程序。您需要到医务人员那里定期复诊，以观察是否有任何变化。您还可能需要物理、作业和言语治疗。
准备您的预约
A subarachnoid hemorrhage is a medical emergency, so it is likely to be treated in the emergency department. Doctors who specialize in the brain and nervous system may be involved in your care. These specialists may include neurologists, neurosurgeons and neuroradiologists.
What you can do
To make the most of your time with your healthcare team, be ready with the following information. Make a list of:
- Your symptoms, including any that seem unrelated to the reason for seeking medical care.
- Key personal information, including major stresses, recent life changes and family medical history.
- All medicines, vitamins or other supplements you take, including the doses.
- Questions to ask your healthcare team.
For subarachnoid hemorrhage, some basic questions to ask your healthcare professional include:
- What's likely causing my symptoms?
- Other than the most likely cause, what are other possible causes for my symptoms?
- What tests do I need?
- Is my condition likely short-term or long-lasting?
- What's the best course of action?
- What are the alternatives to the primary approach you're suggesting?
- I have these other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your healthcare professional is likely to ask you several questions, such as:
- When did your symptoms begin?
- Have your symptoms been constant, or do they come and go?
- How serious are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?