Description

A subarachnoid hemorrhage is bleeding in the space between the brain and the tissues covering the brain. The space is known as the subarachnoid space. A subarachnoid hemorrhage is a type of stroke. It is a medical emergency that requires immediate treatment.

The main symptom of a subarachnoid hemorrhage is a sudden, severe headache. Some people describe it as the worst pain I have ever felt. A subarachnoid hemorrhage can also cause nausea, vomiting, neck stiffness and other symptoms.

The bleeding usually occurs when a bump spot in a blood vessel, known as an aneurysm bursts in the brain. Bleeding may also occur due to an injury to the head. Sometimes a tangle of blood vessels in the brain, known as an arteriovenous malformation, causes the bleeding. And other health conditions, including conditions that affect the blood vessels, it can cause bleeding.

If subarachnoid hemorrhage is not treated, it can lead to permanent brain damage or death, so it is important to get treatment right away.

Symptoms

The most common symptom of subarachnoid hemorrhage is a very sudden, very bad headache. The headache starts in a fraction of a second and it becomes very painful immediately. Some people describe it as the worst headache I have ever had.

Along with a sudden headache, symptoms may include:

  • Nausea.
  • Vomiting.
  • Neck stiffness or neck pain.
  • Changes in vision.
  • Brief loss of consciousness.

When to see a doctor

A subarachnoid hemorrhage is a medical emergency.

Get immediate medical attention if you experience a sudden, severe headache or if you have other symptoms of a subarachnoid hemorrhage. This is especially important if you have been diagnosed with a brain aneurysm, or if you have suffered a head injury.

If you're with someone who is complaining of a severe headache that came on suddenly or loses consciousness, call 911 or the local emergency number.

Causes

A subarachnoid hemorrhage can be caused by:

  • A cerebral aneurysm that has burst. A brain aneurysm is a bulge in a blood vessel in the brain. The aneurysm may rupture and cause bleeding into the space between the brain and the tissues that cover the brain, known as the subarachnoid space. A cerebral aneurysm is the most common cause of subarachnoid hemorrhage.
  • Head injury. Another common cause is an injury to the head. A head injury from a car accident, a fall or violence can lead to a subarachnoid hemorrhage.
  • A tangle of blood vessels in the brain, known as the arteriovenous malformation. This irregular tangle of blood vessels can rupture and cause bleeding in the brain.
  • Inflammation of the blood vessels, known as vasculitis. This can cause the walls of the blood vessels to thicken and narrow. Vasculitis can lead to a blood clot or an aneurysm.

Risk factors

Some risk factors for subarachnoid hemorrhage are not under your control. They include:

  • Be of legal age. Most of the hemorrhages, subarachnoid that the result of an aneurysm occur in people between the ages of 55 and 60. Women in their 50's and 60's, in particular, have a higher risk.
  • Having a first-degree relative with a brain aneurysm. This includes a parent, child or sibling related by blood
  • Have certain health conditions. Conditions that increase the risk of subarachnoid hemorrhage include Ehlers-Danlos syndrome, Marfan syndrome, neurofibromatosis type 1, and polycystic kidney disease.

People who have two or more first-degree relatives with brain aneurysms or who have had a subarachnoid hemorrhage can be screened.

Other risk factors for subarachnoid hemorrhage can be avoided. They include:

  • Having high blood pressure.
  • The habit of smoking.
  • The abuse of alcohol.
  • The use of drugs such as cocaine and methamphetamine.

Diagnosis

For the diagnosis of a subarachnoid hemorrhage, you may need the following tests:

  • Computed tomography. This imaging test is very effective in the detection of bleeding in the brain. But it can't detect the bleeding if you have a low red blood cell count or if there is a small amount of bleeding. Your healthcare provider may inject a contrast dye to view your blood vessels in greater detail, known as computed tomography angiography.
  • The magnetic resonance imaging. This imaging test also can detect bleeding in the brain. A magnetic resonance imaging may show signs of subarachnoid hemorrhage in exceptional cases, when it is not detected by a ct scanner. Your healthcare provider may inject a dye into a blood vessel to view the arteries and veins in greater detail, known as MR angiography.
  • Cerebral angiography. You may have a cerebral angiography to obtain more detail of the images. Angiography may also be done if a subarachnoid hemorrhage is suspected, but the cause is not clear or does not appear in other images. A long, thin tube called a catheter is inserted into an artery and passed into his brain. Dye is injected into the blood vessels of your brain to make them visible on x-ray images. sometimes a cerebral angiogram does not show an aneurysm. If this happens, you can have a second angiography if your healthcare professional thinks an aneurysm is likely.

For some people with an aneurysm that caused a subarachnoid hemorrhage, the bleeding may not be displayed on the first image. If this happens, you may need a lumbar puncture. During this procedure, a needle is inserted into the lower part of the back. A small amount of the fluid that surrounds the brain and spinal cord, known as cerebrospinal fluid, is removed. The liquid was studied to search in the blood, which may mean that you have a subarachnoid hemorrhage.

Treatment

Treatment of subarachnoid hemorrhage focuses on the stabilization of the condition. Your health care team checks your blood pressure, breathing and blood flow.

If you have a burst aneurysm, is treated by her and her team of health works to prevent complications.

For the treatment of a ruptured brain aneurysm, your health care professional may recommend:

  • Surgery. The surgeon makes an incision in the scalp and the location of the brain aneurysm. A metal clip is placed in the aneurysm to stop the flow of blood.
  • Endovascular embolization. The surgeon inserts a catheter into an artery and threads to your brain. Detachable platinum coils are guided through the catheter and placed in the aneurysm. The coils reduce the flow of blood into the aneurysm and cause the blood to clot. Different types of coils have been developed for the treatment of aneurysms.
  • Other endovascular treatments. Certain aneurysms can be treated with endovascular embolization using the latest technology. These new techniques are included stent-assisted or balloon-assisted coiling or devices which deflect the flow of blood.

The treatment of the ruptured aneurysm quickly can help prevent bleeding from happening again.

It is also important to avoid other complications. A subarachnoid hemorrhage can lead to a low in salts such as sodium in the blood. It can also cause high or low levels of sugar in the blood. Your healthcare team monitors these levels, and treat them if necessary.

You can also be poor blood flow to the brain. A frequent complication of subarachnoid hemorrhage due to a burst aneurysm is a constriction and narrowing of the blood vessels in the brain, known as vasospasm. This can cause a stroke if the blood flow decreases to a certain level. A stroke can be prevented by elevation of blood pressure or enlargement of the blood vessels in the brain with drugs. Medicine nimodipine (Nymalize) can also reduce the risk of vasospasm.

Another common complication is a buildup of fluid in cavities within the brain, known as hydrocephalus. This can be treated with drainage channels inserted in the head or in the bottom of the back.

Sometimes, the procedure should be repeated. After your initial treatment, follow-up appointments with your health care team are important to observe the changes. You may also need physical, occupational, and speech therapies.

Preparing for your appointment

A subarachnoid hemorrhage is a medical emergency, so is likely to be treated in the emergency department. Doctors who specialize in the brain and the 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 health care team, be prepared with the following information. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for seeking medical attention.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All medications, vitamins or supplements that you are taking, including the dosage.
  • Questions to ask your health care team.

For subarachnoid hemorrhage, some basic questions to ask your health care professional include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • Is my condition likely to be short-term or long-term?
  • What is 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?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your healthcare provider is likely to ask several questions, such as:

  • When did your symptoms begin?
  • The symptoms been constant or come and go?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Subarachnoid hemorrhage