Subarachnoid Hemorrhage Symptoms and Treatment

Subarachnoid hemorrhage or subarachnoid hemorrhage means that there is bleeding in the space surrounding the brain. Most often, this condition occurs when a weak area in a blood vessel (aneurysm) on the surface of the brain ruptures and leaks.

Blood then collects around the brain and in the skull, increasing pressure on the brain. This can lead to brain cell damage, lifelong complications, and disability. Subarachnoid hemorrhage is an emergency and medical attention is needed.

Causes and risk factors Subarachnoid Hemorrhage

Reported by the National Library of Medicine, subarachnoid hemorrhage can be caused by:

• Bleeding from a network of blood vessels is called an arteriovenous malformation.
• Bleeding disorders.
• Bleeding from a cerebral aneurysm (a weak area in the blood vessel wall that causes the vessel to swell or swell).
• Head injury.
• Unknown cause (idiopathic).
• Use of blood thinners.
• Subarachnoid hemorrhage caused by injury is often seen in older people who fall and hit their heads. In young children, the most common injury that causes subarachnoid hemorrhage is a motor vehicle accident.

Risk factors for subarachnoid hemorrhage include:

• Unruptured aneurysms in the brain and other blood vessels.
• Fibromuscular dysplasia and other autoimmune and connective tissue disorders.
• High blood pressure.
• History of polycystic kidney disease.
• Smoke.
• Use of illegal drugs such as cocaine and methamphetamine.
• Use of blood thinners such as warfarin.
• A strong family history of aneurysms can also increase the risk.

Subarachnoid Hemorrhage Symptoms

There are usually few symptoms of an aneurysm causing a subarachnoid hemorrhage. Sometimes, this aneurysm presses on a nerve or bleeds a little before it ruptures, causing warning signs. As described on the UF Health page, these symptoms, which can occur minutes to weeks before breaking out, include:

• Severe headache.
• facial pain
• Double vision, drooping eyelids, or other vision problems.
• If these symptoms appear, seek medical attention immediately so that appropriate steps can be taken to prevent massive bleeding.

If the aneurysm ruptures, it can produce the following symptoms:

• Sudden severe headache.
• A brief loss of consciousness that often follows the onset of a headache.
• Some people remain in a coma, but most often wake up feeling confused and sleepy. Within minutes or hours, the person may again feel confused and sleepy.
• Vomit.
• Dizzy.
• Frequent fluctuations in heart rate and respiratory rate are common.
• seizures
• Paralysis on one side of the body or neurological problems (this usually occurs in about 25 percent of people who have a subarachnoid hemorrhage).

Diagnosis

If you have symptoms of subarachnoid hemorrhage, your doctor may use several tests to diagnose it. According to Johns Hopkins Medicine, these can include:

• MRI scan: This test uses a large magnet, radiofrequency energy, and a computer to make detailed pictures of the brain.
• CT scan: This test uses X-rays and computer technology to make horizontal or axial images (often called slices) of the brain. CT scans are more detailed than general X-rays.
• Angiogram: During this test, dye is injected into a blood vessel and then X-rays are taken to evaluate blood flow through it.
• Lumbar puncture: In this test, a special needle is placed in the lower back, into the spinal canal. The pressure in the spinal canal and brain can be measured. A small amount of cerebrospinal fluid can be removed and analyzed for the presence of blood.
• The diagnosis of a cerebral aneurysm is usually not made until a subarachnoid hemorrhage has occurred.

Handling

The goals of treating subarachnoid hemorrhage are to:

• Save life.
• Correct the cause of the bleeding.
• Relieve symptoms.
• Prevent complications such as permanent brain damage (stroke)

Surgery:

• Removing a large collection of blood or reducing pressure on the brain if the bleeding is caused by an injury.
• Repair the aneurysm if the bleeding is caused by a ruptured aneurysm
• If critically ill, surgery may have to wait until the patient is more stable.

Surgery may involve:

• Craniotomy (cutting a hole in the skull) and aneurysm clipping, to close the aneurysm.
• Endovascular coils, i.e. placing a coil in the aneurysm and a stent in the vessel to enclose the coil reduces the risk of further bleeding.
• If no aneurysm is found, the patient should be closely monitored by the healthcare team and may need more imaging tests.

Treatment for coma or decreased alertness includes:

• Drain tubes are placed in the brain to relieve pressure.
• Life support.
• Methods to protect the airway.
• Custom positioning.
• Special medication to reduce swelling in the skull.
• A person who is sober may need complete bed rest. The person will be told to avoid activities that can increase pressure inside the head, such as bending, straining and suddenly changing positions.

Treatment may also include:

• Medicines are given through an IV to control blood pressure.
• Drugs to prevent arterial spasms.
• Painkillers and anti-anxiety medications to relieve headaches.
• Medicines to prevent or treat seizures.
• Stool softeners or laxatives to prevent straining during bowel movements
• Medication to prevent seizures.
• The odds for a person experiencing a subarachnoid hemorrhage depend on a number of different

factors, including:

• Location and amount of bleeding.
• Complications.
• Older age and more severe symptoms may lead to a poorer prognosis.
• Some people recover completely after treatment, while some die even with treatment.

Complications that can occur

Subarachnoid hemorrhage can cause brain damage, which can cause long-term or even permanent problems. Possible long-term complications include:

• Physical problems: Subarachnoid hemorrhage can cause physical difficulties, such as drowsiness and tiredness, numbness or weakness in some parts of the body, difficulty swallowing, and loss of balance.
• Cognitive problems: Subarachnoid hemorrhage can cause cognitive dysfunction, including memory problems, difficulty concentrating, and difficulty planning and performing complex tasks.
• Speech difficulties: Subarachnoid hemorrhage can cause slurred or slowed speech. Can also have trouble finding the right words to express yourself.
• Mental health conditions: Subarachnoid hemorrhage is a major life event. This can lead to mental health conditions, such as depression, generalized anxiety and post-traumatic stress disorder (PTSD).

These long term complications managed and treated with several types of therapy, including:

• Physical therapy.
• Occupational therapy.
• Speech therapy.
• Psychotherapy (talk therapy).
• Certain medications can also help. Consult a doctor if you experience any of these problems.

A sudden severe headache could be a sign of a subarachnoid hemorrhage. This is a serious, life-threatening condition that requires immediate medical attention and emergency treatment.

If you have a brain aneurysm that hasn’t ruptured, consult your doctor about the risks and benefits of the various treatment and management options.