A subarachnoid hemorrhage (SAH) accounts for 1 to 7 percent of all strokes. This medical emergency can lead to death or severe disability. HonorHealth's Osborn Medical Center and John C. Lincoln Medical Center offer comprehensive treatment options for subarachnoid hemorrhages — traumatic and non-traumatic alike.
Understanding Subarachnoid Hemorrhage
A subarachnoid hemorrhage is a serious, life-threatening type of stroke caused by bleeding in the area between the brain and the thin tissues that cover the brain called subarachnoid space. When blood is released into the subarachnoid space, it irritates the lining of the brain, increases pressure on it, and damages brain cells. During the same time, the oxygen-rich blood from the affected artery is deprived of blood that goes to the brain, resulting in a stroke.
Subarachnoid hemorrhage can be caused by:
- Head injury.
- Cerebral aneurysm.
- Use of blood thinners.
- Bleeding disorders.
- Bleeding from an arteriovenous malformation.
- An unknown cause.
A subarachnoid hemorrhage occurs in an estimated 40 to 50 out of 100,000 people over the age of 30. It is slightly most common in women than men. Risks include:
- Aneurysms in other blood vessels.
- Fibromuscular dysplasia.
- High blood pressure.
- History of polycystic kidney disease.
The main symptom of a subarachnoid hemorrhage is a severe headache that starts suddenly and is often worse near the back of the head. Patients often describe their pain as "the worst headache ever" and unlike any other type of headache pain. The headache may start after a popping or snapping feeling in the head. Other symptoms include:
- Nausea and vomiting.
- Stiff neck.
- Sensitivity to light.
- Vision problems including blurred or double vision, blind spots or temporary loss in one eye.
- Loss of consciousness.
- Difficulty or loss of movement or feeling.
- Mood and personality changes, including confusion and irritability.
- Muscle aches (especially neck and shoulder pain).
If you or someone you know is experiencing any symptoms of a subarachnoid hemorrhage, call 911 immediately.
Tests and Treatment
The first priority is stabilizing the patient. Test for subarachnoid hemorrhages vary depending on the underlying cause of the bleeding and the extent of damage to the brain:
- A physical exam might show a stiff neck due to irritation by blood of the meninges, the tissues that cover the brain. Except for those in a deep coma, patients with a subarachnoid hemorrhage may resist neck movement.
- An eye exam could be performed. Decreased eye movements can be a sign of damage to the cranial nerves. In milder cases, no problems may be seen on an eye exam.
- If your doctor thinks you might have a subarachnoid hemorrhage, a head CT scan could be done immediately. In some cases, the scan might be normal, especially if there has only been a small bleed. If the CT scan is normal, a lumbar puncture (spinal tap) should be performed. Patients with SAH will have blood in their spinal fluid.
- CT scan angiography might be done to look for evidence of SAH and aneurism.
- Cerebral angiography of blood vessels of the brain can show small aneurysms or other vascular problems. The test can pinpoint the exact location of the bleed and can tell if there are blood vessel spasms.
- Transcranial Doppler ultrasound looks at blood flow in the arteries of the brain that run inside the skull. The ultrasound beam is directed through the skull. It also can detect blood vessel spasms and may be used to guide treatment.
- Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) occasionally are used to diagnose a subarachnoid hemorrhage or find other associated conditions.
One of the first measures after a subarachnoid hemorrhage occurs is to stop the bleeding or prevent the risk of bleeding again. If a subarachnoid hemorrhage is from a ruptured aneurysm, surgery could be performed to stop the bleeding. Treatment options are either surgical or endovascular intervention.
Recovery largely depends on the severity. In general, one-third of patients who suffer from a subarachnoid hemorrhage will survive with good recovery. Patients may suffer from short-term and/or long-term deficits as well.
Common problems faced by patients following a brain injury include:
- Physical limitations.
- Short-term memory loss.
- Speech and language deficits.
- Weakness or paralysis in arms and legs.
- Visual problems.
- Side effects from medications.
- Lack of attention or concentration.
- Personality changes.