小结
定义
病史和体格检查
关键诊断因素
- 突发剧烈头痛
- 意识水平低下/意识丧失
- 颈部僵硬和肌肉疼痛（假性脑膜炎）
- 危险因素
- 眼睑下垂、复视伴瞳孔散大、眼眶疼痛
其他诊断因素
- 畏光
- 恶心/呕吐
- 意识模糊
- 先兆性头痛既往史
- 癫痫发作
- 复视
- 视力丧失
- 激越
- 局灶神经系统功能障碍
危险因素
- 高血压
- 吸烟
- 家族史
- 常染色体显性遗传性多囊肾病 (ADPKD)
- 饮酒
- 使用可卡因
- 马凡综合征
- Ehlers-Danlos 综合征
- 弹性纤维假黄瘤
- I 型神经纤维瘤病
诊断性检查
首要检查
- 头颅 CT 平扫
- 全血细胞计数 (FBC）
- 血清电解质
- 凝血功能检查
- 肌钙蛋白 I
- 血清葡萄糖
- 心电图（ECG）
需考虑的检查
- 腰椎穿刺术 (LP)
- CT 血管造影 (CTA)
- 数字减影血管造影（DSA）或磁共振血管造影（MRA）
- 脑电图 (EEG)
治疗流程
GCS 评分 ≤8 或评分下降
GCS 评分 ≥9
伴有症状血管痉挛或 DCI
撰稿人
专家顾问
Matthew Jones
Consultant Neurologist
Greater Manchester Neurosciences Centre
Salford Royal Foundation Trust
Honorary Senior Lecturer
University of Manchester
Manchester
UK
利益声明
MJ is the chair of the Association of British Neurologists Education Committee (unpaid position). MJ is a faculty member of an MRCP revision course.
Rachael Power, MBChB, MRCP
Neurology Registrar
Manchester Centre for Clinical Neurosciences
Manchester
UK
利益声明
RP declares that she has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Salah Keyrouz MD, FAHA
Associate Professor
Neurology and Neurosurgery
Washington University School of Medicine
St. Louis
MO
利益声明
SK is an author of a reference cited in this topic.
同行评议者
Tim Harris
Professor of Emergency Medicine
Barts Health NHS Trust
London
UK
利益声明
Diederik Bulters
Consultant Neurosurgeon
University Hospital Southampton NHS Foundation Trust
Southampton
Hampshire
UK
利益声明
DB is the chief investigator for the 'SFX-01 after SAH' trial sponsored by Evgen Pharma. He receives no payment from and has no financial interest in Evgen Pharma.
Nicholas Borg
Registrar
University Hospital Southampton NHS Foundation Trust
Southampton
Hampshire
UK
利益声明
NB declares that he has no competing interests.
编辑
Helena Delgado-Cohen
Section Editor, BMJ Best Practice
利益声明
HDC declares that she has no competing interests.
Luisa Dillner
Head of Research and Development, BMJ
利益声明
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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