Definition
Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space.
Symptoms
The main symptom is a severe headache that starts suddenly and is often worse near the back of the head. Patients often describe it 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:
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Definition
Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space.
Symptoms
The main symptom is a severe headache that starts suddenly and is often worse near the back of the head. Patients often describe it 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:
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Causes
Subarachnoid hemorrhage can be caused by:
Injury-related subarachnoid hemorrhage is often seen in the elderly who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes.
Subarachnoid hemorrhage due to rupture of a cerebral aneurysm occurs in approximately 10-15 out of 10,000 people. However, some studies suggest that number may be slightly lower. Subarachnoid hemorrhage due to rupture of a cerebral ...
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Treatment
The goals of treatment are to save your life, repair the cause of bleeding, relieve symptoms, and prevent complications.
If the hemorrhage is due to an injury, surgery is done only to remove large collections of blood or to relieve pressure on the brain.
If the hemorrhage is due to the rupture of an aneurysm, surgery is needed to repair the aneurym. If the patient is critically ill, surgery may have to wait until the person is more stable. Surgery may involve a craniotomy and aneurysm clipping, which closes the aneurysm, or endovascular coiling , a procedure in which coils are placed within the aneurysm to prevent further bleeding.
If no aneurysm is found, the person should be closely watched by a health care team and may need repeated imaging tests.
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Other Names
Hemorrhage - subarachnoid
Possible Complications
Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is significantly worsened.
Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.
Other complications include:
- Stroke
- Seizures
- Medication side effects
- Complications of surgery
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Outlook (Prognosis)
How well a patient with SAH does depends on a number of different factors, including the location and extent of the bleeding, as well as any complications. Older age and more severe symptoms from the beginning are associated with a poorer prognosis.
Complete recovery can occur after treatment, but death may occur in some cases with or without treatment.
Prevention
Identification and successful treatment of an aneurysm would prevent subarachnoid hemorrhage.
Exams and Tests
A physical exam may show a stiff neck due to irritated meninges, the tissues that cover the brain. Except those in a deep coma, persons with a subarachnoid hemorrhage may resist neck movement.
A neurological exam may show signs of decreased nerve and brain function (focal neurologic deficit ).
An eye exam may show signs of bleeding in the brain. 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 may have a subarachnoid hemorrhage, a head CT scan (without dye contrast) should be immediately done. In some cases, the scan may be normal, especially if there has only been a small bleed. If the ...
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References
Kirmani JF, Alkawi A, Ahmed S, et al. Endovascular treatment of subarachnoid hemorrhage. Neurol Res . 2005;27 Suppl 1:103-7.
Edlow JA. Diagnosis of subarachnoid hemorrhage. Neurocrit Care . 2005;2(2):99-109.
Bird S. Failure to diagnose: subarachnoid haemorrhage. Aust Fam Physician . 2005 Aug;34(8):682-3.
Marx J. Rosens Emergency Medicine: Concepts and Clinical Practice . 5th ed. St. Louis, Mo: Mosby; 2002:2362-2363.
