Subarachnoid Hemorrhage


Last Updated December 20th, 2021

What is a subarachnoid hemorrhage?

The subarachnoid space is the space between the brain and surrounding tissues where the cerebrospinal fluid circulates. Subarachnoid hemorrhage is bleeding from a blood vessel in the brain into the subarachnoid space, the space between the brain and its surrounding membrane. The subarachnoid hemorrhage is considered a case of a hemorrhagic stroke.

The primary symptom is a sudden and severe headache. Other symptoms associated with this are nausea, vomiting, and a brief loss of consciousness. It can occur quickly and most often is the result of head trauma. Call 911 as soon as you notice the symptoms of subarachnoid hemorrhage.

A small but significant percentage of those affected by SAH die even before they reach the hospital. As many as 25% of the patients die in 24 hours because of subarachnoid hemorrhage, with or without medical care.

Symptoms of a subarachnoid hemorrhage

The primary symptom of a subarachnoid hemorrhage is a severe headache. Some people have recounted it as the worst headache they have ever had. The intensity of the pain is more at the base of the skull. Some other symptoms that have been noticed are:

  • Numbness
  • Irritability
  • Confusion
  • Nausea
  • Vomiting
  • Neck and shoulder pain
  • Decreased vision
  • Seizures
  • Double Vision
  • Rapid loss of alertness

The onset of the medical condition is very quick and it could lead to loss of consciousness. Therefore, it is important to seek medical attention as soon as you experience any of the above symptoms and you have a severe headache.

Causes of subarachnoid hemorrhage

Berry aneurysms

Subarachnoid hemorrhage can result from brain traumas or spontaneously. Spontaneous cases of subarachnoid hemorrhage are generally related to aneurysms. These are abnormalities within the brain’s arteries. Sometimes they are referred to as berry aneurysms because they cause clusters of sac-like pouches to form on the arteries in the brain. These clusters often resemble berries. Hence the name berry aneurysm.

When an aneurysm erupts, it bleeds and then forms a clot. This condition is responsible for most cases of subarachnoid hemorrhage. Aneurysmal hemorrhage can happen at any age, but it more common between 40 and 65. Brain aneurysms are more common in smokers, women, and those with high blood pressure. In some cases, trauma to the brain during an injury can cause aneurysms and this could result in subarachnoid hemorrhage.

Other causes of subarachnoid hemorrhage include:

  • Bleeding disorders
  • Bleeding from an arteriovenous malformation (AVM) or a tangle of blood vessels in your brain
  • Use of blood thinners

Risk factors for subarachnoid hemorrhage

We can better understand the risk for subarachnoid hemorrhage by understanding what increases the risk for an aneurysm. Some people are born with aneurysms. Also, subarachnoid hemorrhage can happen at any age. The following can increase the risk of an aneurysm:

  • According to the Internet Stroke Center, aneurysms are more common in women than men. The difference in the incidence of subarachnoid hemorrhage based on gender starts at the age of 55. The gap widens thereafter and reaches as high as 1.24 times in women as compared to men.
  • In a study presented in a stroke conference at New Orleans, it was concluded that smoking could lead to multiple aneurysms in the brain. It was also concluded that it increases the chances of an aneurysm rupturing as well.
  • Hypertension is also believed to increase the risk of a subarachnoid hemorrhage. According to a study conducted from 1994 to 1998, patients with hypertension had a nearly seven-fold higher risk of aneurysmal subarachnoid hemorrhage.
  • Alcohol, which has a detrimental effect on blood pressure, might increase the risk of subarachnoid hemorrhage.
  • The use of drugs, particularly cocaine and methamphetamine, increase significantly the risk of not only developing an aneurysm but also subarachnoid hemorrhage.
  • The risk of AVM rupture is higher during pregnancy.

One in 50 people in the United States have unruptured aneurysms. If you have a history of brain aneurysms, consult a doctor. This helps to take care of them before they rupture and lead to subarachnoid hemorrhage.

Diagnosis of subarachnoid hemorrhage

A physical exam and the presence of a severe headache help to conclude that subarachnoid hemorrhage is present. The physical exam in cases of subarachnoid hemorrhage usually reveals a stiff neck and a loss of vision. If the doctor feels further tests are needed to confirm subarachnoid hemorrhage, then he might conduct imaging tests.

Physical Exam

Physical examination findings may be normal or may include the following:

  • Mild to moderate BP elevation
  • Papilledema (loss of vision)
  • Tachycardia (elevated heart beat rate)
  • Temperature elevation
  • Retinal hemorrhage
  • Neurologic abnormalities

Imaging Tests

Imaging tests are done to help with the diagnosis of subarachnoid hemorrhage. Some of them are:

  • CT Scan: A dye is injected into the blood to view blood vessels in greater detail. This helps to identify any bleeding in your brain
  • MRI scan: A high contrast dye is injected into the blood, which helps in the imaging of the blood vessels. It also provides a detailed picture of the blood flow.
  • Cerebral Angiography: It involves the threading of a catheter from an artery in your leg up to the brain. A dye is then injected into the blood vessels of your brain to reveal any bleeding in the brain. Cerebral angiography is generally the last of the three imaging tests that are performed. It is done when the cause of the hemorrhage is not clear or if the previous two tests are negative for subarachnoid hemorrhage.
  • Transcranial ultrasound: Ultrasound is used to generate a detailed image of the brain and its blood vessels.

Lumbar Puncture

A good percentage (22%) of the cases of subarachnoid hemorrhage does not show up in initial image testing. The doctor then might go for a Lumbar puncture. In lumbar puncture, the cerebrospinal fluid is drawn from the back and it is examined. If there is any blood present in the cerebrospinal fluid, it points to a case of subarachnoid hemorrhage.

The lumbar puncture test could be positive for subarachnoid hemorrhage. In such a case, the doctor might order a repeat of the imaging tests to confirm that the condition exists. Subarachnoid hemorrhage is often misdiagnosed because 73% of the people do not get scans.

Treatment of subarachnoid hemorrhage

Rapid treatment is a necessary course of action in any case of subarachnoid hemorrhage. This will help to reduce the risk of mortality or further brain damage.

There is continuous bleeding and build up of pressure in the subarachnoid space. This may require draining out of the cerebrospinal fluid and the administering of other medications to reduce the bleeding and the pressure. This is the first course of action. Second, the cause of the subarachnoid hemorrhage needs to be identified. The aneurysm needs to be closed or clipped by surgery.

If your aneurysm needs to be clipped, generally a craniotomy is done. The skull is opened to reveal the affected portion and then the aneurysm is clipped surgically. However, a minimally invasive procedure called endovascular coiling also may be used. In endovascular coiling, a catheter is inserted into the groin until it reaches the aneurysm. Platinum coils are then released. These coils reach the aneurysm and cause embolization or clotting of the aneurysm.

The choice made between clipping or coiling is based on the location of the lesion and the availability and experience of hospital staff.

If subarachnoid hemorrhage induces a coma, then the patient will be on life support with ventilation, the air passageways will be kept open, and the cerebrospinal fluid will be drained regularly to prevent a build-up of pressure.

If you do not become unconscious or enter into a coma, you will still be given instructions to follow that will help prevent post-treatment coma. You may be advised rest and asked not to strain your body. Straining your body can increase a build-up of pressure in your brain and could lead to a worsening of the condition.

Because of the pulmonary complications that can develop later, the patients must go in for a baseline chest radiograph. This will serve as a reference point to evaluate pulmonary complications that may develop later. An ECG of the patient is also taken for evaluation in case of later cardiac complications.

Your doctor may prescribe medications to:

  • Regulate blood pressure with medication through an IV
  • Reduce the severity of headaches with painkillers and antianxiety medications
  • Prevent artery spasms with nimodipine

Complications after subarachnoid hemorrhage treatment

Unfortunately, treatment for subarachnoid hemorrhage does not cure the condition always. In fact, in many cases repeated bleeding occurs. Repeated bleeding happens when an aneurysm that has healed ruptures again. This could lead to coma or death.

Some people have also reported having seizures, strokes, and cardiac and pulmonary complications post treatment.

Preventing a subarachnoid hemorrhage

The only possible way to prevent a subarachnoid hemorrhage is to stop the problem where it starts. Identify the problem spots in your brain and if you have a history of brain aneurysms, keep the doctor informed.

Final Words

Subarachnoid hemorrhage is a medical condition where the affected patients take longer to recover. The chances of a coma or even death post-treatment are quite high if you are older or in poor health. The earlier you seek medical care, the better are your chances of surviving this condition. With recent advancements, the mortality rate of subarachnoid hemorrhage has decreased in the past three decades. It remains a burning problem, with 10–15% of the patients dying before they even reach the hospital. Mortality rates are still high even for those who receive medical attention.

https://www.webmd.com/smoking-cessation/news/20000216/smoking-linked-deadly-brain-aneurysms#1

https://www.webmd.com/heart-disease/atrial-fibrillation/what-are-the-types-of-tachycardia#1

https://www.webmd.com/brain/brain-hemorrhage-bleeding-causes-symptoms-treatments#2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820121/

https://www.ncbi.nlm.nih.gov/pubmed/12212365

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095631/

https://www.mayoclinic.org/diseases-conditions/subarachnoid-hemorrhage/diagnosis-treatment/drc-20361014

https://emedicine.medscape.com/article/1164341-overview

 

Dos and Don'ts

Dos
  • Consult a doctor the moment you have a severe headache and any of the other secondary symptoms.
  • Report the previous history of brain aneurysms (if any).
Don'ts
  • Indulge in recreational drug
  • Consume alcohol
  • Smoke

 

 

 

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Easy and safe tips for ear wax removal you can do at home Cerumen impaction generally occurs when an external object like cotton swabs are used to remove the ear wax.…
LFT-test
Liver Function Test – LFT LFT or Liver Function Test is a blood test used to determine the levels of hepatic enzymes which…
woman with abdominal pain holding ovulation calendar
Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
Jack in the box fast food
Jack In the Box : The perils of surging fast food culture in the USA Jack in the Box - How a culture of fast-food can clog your arteries, weaken your heart, fatten…
L-theanine attention
L-Theanine: Better sleep, higher focus, and many other benefits Did you know that L-theanine found in green tea can make you sleep better and be focused at…
oral hygiene tips
6 shocking consequences of bad oral hygiene (and how to avoid them) Did you know bad breath is not just turning off, but also harms your body in ways you…
GM Diet: The fastest way to lose weight or yet another hoax diet? General Motors started this trend of extreme dieting for 7 straight days to ensure its employees were able…
Goji berry: A traditional Chinese berry that packs the best of antioxidants Goji berry is an ancient berry that is considered to be power-packed with nutrients and antioxidants. Which means…
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
Anti-CCP Test – Anti-Cyclic Citrullinated Peptide Anti-ccp or ACCP test is a blood test that is primarily employed to diagnose the onset of rheumatoid…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
fructosamine test
Fructosamine Test A fructosamine test measures blood sugar glucose content. Fructosamine level can indicate blood sugar level in past 2-3…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
iron deficiency profile
Iron Deficiency Profile An iron deficiency profile is a battery of blood tests which are performed in order to determine the…
hidden benefits walking
9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
sleep deprivation
Don’t let your sleep deficit grow into memory loss or heart attack Why is sleep important for us? How could sleep deprivation harm you? We bet you didn't know about…
biotin for hair
Biotin: One-stop-shop for shiny hair and an active body! What is common to bananas, eggs, sweet potatoes, and liver? These are delicious and rich in biotin ;…
Shilajit: A miracle Himalayan herb for an active and happy life The Himalayas contain more wonders than you thought. Shilajit is a miracle herb that is widely used in…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
What is the right way to take a pregnancy test? A pregnancy test is undertaken to determine if you have conceived. A home pregnancy test is the most…
GERD heartburn
Heartburn: What are the exact symptoms and the best home remedies? There are easy home remedies for heartburn, which not only acts as a first aid when you experience…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
CEA_test
Carcinoembryonic antigen (CEA) test CEA or carcinoembryonic test detects the presence of CEA antigen in your blood mainly & determines the effectiveness…
leptospira Igm test
Leptospira-IgM Test A Leptospira-IgM test is a blood test which is carried out to detect anti-Leptospira IgM antibody. Leptospirosis is…
Hymenoplasty
Hymenoplasty Read on to find out all about hymenoplasty, the procedure, post-surgery care, the risks, and the benefits.
avocado benefits
Avocado: 15 reasons why this fruit should be a staple in your diet Did you know that the word avocado literally means "testicles". Don't get grossed out as this power-packed fruit…
ashwagandha brain
Ashwagandha: The best-kept secret of Ayurveda now revealed! Ashwagandha literally means "smell of horse". Don't get bogged down by that one tiny detail because this ayurveduic…
Salt dangers
Sodium chloride: The wonders and dangers of the simple table salt Sodium chloride is a salt containing sodium and chlorine ions at a 1:1 ratio. It is edible and…
Bromelain: 11 reasons why you should start adding pineapple to your pizza! If you didn't love pineapples already, here are some of the top health benefits that bromelain can bring…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
Experts reveal the safest ways to perform an enema at home The idea of pushing some up your rectal area might make you queasy but an enema could actually…
anoscopy
Anoscopy Anoscopy is an invasive diagnostic procedure where a small device known as anoscope will be inserted in the…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…
aspartame or sugar
Aspartame – Hidden truths about this storm in a teacup Aspartame, the artificial sweetener, has gone under the scanner on several occasions for allegedly doing more harm than…
High Fiber Diet – Fire up your fiber intake for these health benefits! Regular bowels, healthy detox, higher immunity, and guaranteed weight loss - a high fiber diet can bring all…
xylitol gum
Xylitol : Is this the right sugar substitute for you? Discovered during World War 2 owing to sugar shortage, xylitol has become a common name in pharamaceutical industry.…
black seed oil benefits
Black Seed Oil: What secret benefits could it bestow on your health? Black seeds or nigella seeds are tiny packets of health brimming with amazing benefits. Find out why should…
gout diet purines
Gout Diet : Get relief from painful joints by eating these foods Are you a victim of this painful condition? Are medications providing only short relief? Find a list of…
DHEA wrinkles
DHEA: Now get unbelievable age defiance with this wonder hormone! DHEA is known popularly as the age-defying hormone. This supplement is widely used to slow down aging and…
Oil of Oregano: The one-stop essential oil you’ve been looking for Are you plagued by a weak immune system? High body inflammation accompanied by pain and infections? Why not…
Cayenne: The remarkable benefits of these red hot chili peppers These may make you rush for a glass of water, but cayenne pepper is actually a healthy additive…
Is it possible to achieve full body detox with Master Cleanse? Master cleanse is a diet consisting of a lemonade based beverage, a salt water drink and a herbal…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
shakeology woman
Meal replacement or protein drink? Learn all about Shakeology and its claims Shakeology from Beachbody claims to be the most suitable shake that can aid in weight loss, regulate blood…
ANTIPHOSPHOLIPIDANTIBODY(APL)_IgG
Antiphospholipid (APL) antibody-IgG The Antiphospholipid Antibody testing is a blood test used to determine an autoimmune disorder called Antiphospholipid syndrome linked…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
cystatin C
Cystatin C Test Cystatin C is a specific single-chain protein that is found in body fluids and is a biomarker for…
piles fissure fistula
Allopathy vs homeopathy vs ayurveda treatment for piles, fissures, and fistula Read to know the best form of treatment among allopathy, homeopathy,or ayurveda for piles, fissures, and fistula
liver detox facts
7 liver detox facts and why ignoring these could kill you! Are you taking care of this organ that handles over 500 different vital functions in your body? Your…
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Gallbladder surgery :Tips on post-operative care and diet What to eat post a gallbladder surgery? What are the key things to avoid if you had a…
Are you sure you are drinking enough water? Everyone says, drink 8 glasses of water per day. But how much truth is there in this rule…
Green, brown, & bitter: The instant advantages of including fenugreek in your diet Did you know the earliest usage of fenugreek can be traced back to the Egyptian civilization? Find out…

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