蛛网膜下腔出血

最后审阅: 4 九月 2022
最后更新: 11 三月 2022

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
完整详情

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
完整详情

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
完整详情

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)
完整详情

需考虑的检查

  • 腰椎穿刺术 (LP)
  • CT 血管造影 (CTA)
  • 磁共振血管成像 (MRA)
  • 数字减影血管造影 (DSA)
  • 脑电图 (EEG)
完整详情

治疗流程

急症处理

GCS 评分 ≤8 或评分下降

GCS 评分 ≥9

持续性治疗

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 declares that he has no competing interests.

Rachael Power,

Neurology Registrar

Manchester Centre for Clinical Neurosciences

Manchester

UK

利益声明

RP has been sponsored by Novartis to attend the International Headache Conference.

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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