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субарахноидального в самаре","retina":false,"avatarId":"0","isHermione":false,"isMacOS":false,"tld":"com.tr","isEmbeddedFuturis":false,"isLoggedIn":false,"brand":"yazeka","reqId":"1759859424356461-548255494634083294-balancer-l7leveler-kubr-yp-klg-15-BAL","device":{"isIOS":false,"platform":"desktop"},"expFlags":{"isFootnoteDetails":true,"isFootnoteRedesignDivided":true,"futurisMultiqueryFlag":true}},"dialogStoreProps":{"baseUrl":"","baseUrlWs":"","orderedPairUUID":["Question"],"requestResponsePairs":{"data":{"Question":{"userMessage":"Кровоизлияние субарахноидальное: что это?","markdown":"**Субарахноидальное кровоизлияние (САК)** — это кровоизлияние в **субарахноидальное пространство** головного мозга, находящееся между паутинной и мягкой мозговыми оболочками [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5)[7](https://yandex.ru/medicine/disease/subarahnoidalnoe-krovoizlijanie). Это одна из форм острого нарушения мозгового кровообращения (ОНМК) [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5). \n\n**Угрожающее жизни состояние**, которое может привести к тяжёлой инвалидизации пациента даже в случае ранней диагностики и адекватного лечения [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5). До половины случаев САК заканчиваются летальным исходом, 10–15% больных погибают ещё до поступления в стационар [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5).\n\n\n\n## Причины\nПричины САК разделяют на первичные и вторичные [6](https://MedPortal.ru/enc/neurology/stroke/subarahnoidalnoe-krovoizliyanie/)[7](https://yandex.ru/medicine/disease/subarahnoidalnoe-krovoizlijanie): \n* **Первичные** — разрыв аневризмы сосудов головного мозга, сосудистые мальформации, заболевания сосудов воспалительного характера или дистрофия их стенок [6](https://MedPortal.ru/enc/neurology/stroke/subarahnoidalnoe-krovoizliyanie/)[7](https://yandex.ru/medicine/disease/subarahnoidalnoe-krovoizlijanie). \n* **Вторичные** — черепно-мозговая травма, ушиб головного мозга тяжёлой степени или сдавление головного мозга [6](https://MedPortal.ru/enc/neurology/stroke/subarahnoidalnoe-krovoizliyanie/). \n\nВ 15–20% случаев установить причину кровоизлияния не удаётся [8](https://www.KrasotaiMedicina.ru/diseases/zabolevanija_neurology/subarachnoid-hemorrhage).\n\n## Симптомы\nПризнаки САК возникают внезапно, без предвестников [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5). Некоторые симптомы: \n* резкая головная боль (напоминает «удар по голове») [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5)[11](https://ProBolezny.ru/krovoizliyanie-subarahnoidalnoe/); \n* тошнота, повторная рвота [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5); \n* часто наступает утрата сознания [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5); \n* характерно психомоторное возбуждение [2](https://ru.wikipedia.org/wiki/%D0%A1%D1%83%D0%B1%D0%B0%D1%80%D0%B0%D1%85%D0%BD%D0%BE%D0%B8%D0%B4%D0%B0%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D0%BA%D1%80%D0%BE%D0%B2%D0%BE%D0%B8%D0%B7%D0%BB%D0%B8%D1%8F%D0%BD%D0%B8%D0%B5). \n\nВ течение 6–24 часов после кровоизлияния возникает раздражение мозговых оболочек кровью, что приводит к развитию менингеального синдрома (ригидности шейных мышц, симптомов Кернига и Брудзинского) [11](https://ProBolezny.ru/krovoizliyanie-subarahnoidalnoe/).\n\n## Диагностика\nДля диагностики САК могут применяться: \n* **Компьютерная томография (КТ)** — ведущий метод, особенно в первые сутки [11](https://ProBolezny.ru/krovoizliyanie-subarahnoidalnoe/). Позволяет оценить объём и расположение крови в цистернах — участках расширения субарахноидального пространства [11](https://ProBolezny.ru/krovoizliyanie-subarahnoidalnoe/). \n* **МРТ головного мозга** — информативность этого метода увеличивается с течением времени, поэтому его чаще применяют при подострых и хронических кровоизлияниях [11](https://ProBolezny.ru/krovoizliyanie-subarahnoidalnoe/). \n* **Поясничная пункция** — субарахноидальное кровоизлияние можно подтвердить с помощью забора ликвора, но этот метод применяют редко — только в сомнительных случаях, чтобы уточнить диагноз [11](https://ProBolezny.ru/krovoizliyanie-subarahnoidalnoe/).\n\n## Лечение\nЛечение назначает врач-невролог [7](https://yandex.ru/medicine/disease/subarahnoidalnoe-krovoizlijanie). Терапия проходит в неврологическом стационаре и зависит от тяжести состояния больного [7](https://yandex.ru/medicine/disease/subarahnoidalnoe-krovoizlijanie). Некоторые методы лечения: \n* **Медикаментозная терапия** — направлена на уменьшение внутричерепного давления, предотвращение спазмов сосудов и облегчение боли [12](https://www.Vertebra.clinic/lechenie/napravleniya-lecheniya/nevrologiya/subarakhnoidalnoe-krovoizliyanie/). Могут назначить препараты для снижения давления, антикоагулянты, противоспазматики и другие лекарственные средства в зависимости от клинической картины и состояния пациента [12](https://www.Vertebra.clinic/lechenie/napravleniya-lecheniya/nevrologiya/subarakhnoidalnoe-krovoizliyanie/). \n* **Хирургическое вмешательство** — для устранения источника кровотечения, например, клипирование аневризмы [1](https://dr-zavalishin.ru/statii/posledstviya-subarahnoidalnogo-krovoizliyaniya-golovnogo-mozga/)[12](https://www.Vertebra.clinic/lechenie/napravleniya-lecheniya/nevrologiya/subarakhnoidalnoe-krovoizliyanie/). \n\n**При подозрении на САК необходимо незамедлительно вызвать скорую помощь** [7](https://yandex.ru/medicine/disease/subarahnoidalnoe-krovoizlijanie).","linksData":[{"sourceId":1,"url":"https://dr-zavalishin.ru/statii/posledstviya-subarahnoidalnogo-krovoizliyaniya-golovnogo-mozga/","shownUrl":"https://dr-zavalishin.ru/statii/posledstviya-subarahnoidalnogo-krovoizliyaniya-golovnogo-mozga/","title":"Последствия субарахноидального кровоизлияния в головном мозге, консультация и лечение в отделении нейрохирургии ГКБ им. 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