Long Brit, Koyfman Alex, Runyon Michael S
Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
Emerg Med Clin North Am. 2017 Nov;35(4):803-824. doi: 10.1016/j.emc.2017.07.001. Epub 2017 Aug 24.
Subarachnoid hemorrhage (SAH) is a neurologic emergency due to bleeding into the subarachnoid space. Mortality can reach 50%. The clinical presentation is most often in the form of headache, classically defined as maximal at onset and worst of life. The most common cause is traumatic; approximately 80% of nontraumatic SAH are due to aneurysmal rupture, with the remainder from idiopathic peri-mesencephalic hemorrhage or other less common causes. Noncontrast brain computed tomography (CT) performed within 6 hours of symptom onset has sensitivity approaching 100%. Lumbar puncture may be considered after this period for definitive diagnosis if initial CT is normal.
蛛网膜下腔出血(SAH)是一种因血液流入蛛网膜下腔而导致的神经系统急症。死亡率可达50%。临床表现最常见的形式是头痛,典型表现为起病时最为剧烈,是一生中最严重的头痛。最常见的病因是外伤;约80%的非外伤性SAH是由动脉瘤破裂引起的,其余则由特发性中脑周围出血或其他较罕见的原因导致。在症状发作6小时内进行的非增强脑部计算机断层扫描(CT)敏感性接近100%。如果初始CT正常,在此时间段之后可考虑进行腰椎穿刺以明确诊断。