Subarachnoid hemorrhage care

A subarachnoid hemorrhage, a medical emergency that can lead to death or severe disability, accounts for 1 to 7 percent of all strokes. The HonorHealth Scottsdale Osborn and John C. Lincoln, Deer Valley medical centers offer comprehensive treatment options for subarachnoid hemorrhages — traumatic and non-traumatic alike.

A subarachnoid hemorrhage is a serious, life-threatening stroke caused by bleeding in the area between the brain and the thin tissues called subarachnoid space that cover the brain. When blood is released into the subarachnoid space, it irritates the lining of the brain, increases pressure on it, and damages brain cells.

Causes and risks of subarachnoid hemorrhage

Causes include:

• Head injury
• Cerebral aneurysm
• Use of blood thinners
• Bleeding disorders
• Bleeding from an arteriovenous malformation
• An unknown cause

A subarachnoid hemorrhage occurs in approximately 40 to 50 out of 100,000 individuals over 30. It’s slightly most common in women than men. Risks include:

• Aneurysms in other blood vessels
• Fibromuscular dysplasia, a condition that causes medium-sized arteries to narrow or enlarge
• High blood pressure
• History of polycystic kidney disease
• Smoking

Subarachnoid hemorrhage symptoms

The main symptom of a subarachnoid hemorrhage is a severe headache that starts suddenly; it’s often worse near the back of the head. Often termed the worst headache ever, it may start after you have 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
• Seizures
• 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 has any symptoms of a subarachnoid hemorrhage, call 911 immediately.

Tests and treatment for subarachnoid hemorrhage

The first priority of your HonorHealth neurologist is stabilizing the patient. Tests for subarachnoid hemorrhages depend 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 of the meninges, the tissues that cover the brain, by blood. 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, your neurologist might not see any problems 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 subarachnoid hemorrhage will have blood in their spinal fluid.
• 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 examines blood flow in the arteries of the brain running 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.
• MRI and magnetic resonance angiography (MRA) are sometimes 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 from a subarachnoid hemorrhage

Recovery largely depends on the severity. In general, one-third of patients will survive with good recovery. You 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
• Fatigue
• Headaches
• Lack of attention or concentration
• Personality changes