Subarachnoid Hemorrhage (SAH): Symptoms, Causes, Treatment

What are the symptoms of a subarachnoid hemorrhage?

A subarachnoid hemorrhage (SAH) is a serious condition where bleeding occurs in the space between the brain and the tissues covering it, called the subarachnoid space. The symptoms of SAH can be sudden and severe. Common symptoms include:

Acute Onset Symptoms

• Sudden Severe Headache: Often described as the “worst headache of one’s life,” this headache is abrupt and intense, sometimes described as a “thunderclap” or “explosive” headache.
• Neck Stiffness: Pain and stiffness in the neck, often due to irritation of the meninges (the protective membranes covering the brain and spinal cord).
• Nausea and Vomiting: Accompanied by or following the headache, due to increased intracranial pressure or irritation of the brain.
• Loss of Consciousness: Brief or prolonged loss of consciousness can occur, depending on the severity of the hemorrhage.

Additional Symptoms

• Photophobia: Sensitivity to light.
• Confusion or Altered Mental State: Difficulty thinking clearly, confusion, or altered consciousness.
• Seizures: Some individuals may experience seizures, either as a direct consequence of the hemorrhage or as a complication.
• Visual Disturbances: Blurred vision or double vision, or sudden loss of vision.

Possible Complications

• Neurological Deficits: Weakness, numbness, or difficulty speaking if there is significant brain involvement or secondary complications.
• Reduced Level of Consciousness: Severe cases may lead to a reduced level of consciousness or coma.
• Signs of Increased Intracranial Pressure: Such as swelling, increasing headache, or changes in consciousness.

SAH is a medical emergency requiring immediate attention. If you or someone else exhibits symptoms of SAH, seek emergency medical care right away. Early diagnosis and treatment are crucial for improving outcomes and minimizing complications.

What are the causes of a subarachnoid hemorrhage?

A subarachnoid hemorrhage (SAH) is caused by bleeding into the subarachnoid space, the area between the brain and the surrounding membranes. Several factors can lead to SAH:

Primary Causes

• Aneurysm Rupture: The most common cause of SAH is the rupture of a cerebral aneurysm, which is a weakened, bulging area in the wall of a brain artery. When the aneurysm bursts, it causes bleeding into the subarachnoid space.
• Arteriovenous Malformations (AVMs): AVMs are abnormal connections between arteries and veins in the brain that can rupture and cause bleeding.
• Trauma: Head injuries or trauma can cause bleeding in the subarachnoid space. This is often seen in cases of severe head injury or accidents.

Secondary Causes

• Hypertension: Chronic high blood pressure can weaken blood vessel walls over time, increasing the risk of rupture.
• Blood Vessel Disorders: Conditions such as cerebral vasculitis or moyamoya disease can affect the blood vessels in the brain, leading to bleeding.
• Coagulation Disorders: Blood clotting disorders or the use of anticoagulant medications can increase the risk of bleeding.

Other Contributing Factors

• Genetic Factors: A family history of aneurysms or certain genetic conditions can increase the risk of SAH.
• Smoking and Alcohol Use: These lifestyle factors can contribute to the weakening of blood vessels and increase the risk of aneurysm rupture.
• Intracranial Tumors: Rarely, tumors can erode into blood vessels and cause bleeding.

While SAH is often related to specific underlying conditions or risk factors, it can occur spontaneously without an obvious cause. Identifying and managing these risk factors is important for prevention and treatment. If SAH is suspected, immediate medical evaluation and treatment are essential.

What is the treatment for a subarachnoid hemorrhage?

The treatment for a subarachnoid hemorrhage (SAH) involves several important steps aimed at stabilizing the patient, controlling the bleeding, preventing complications, and aiding long-term recovery.

Initially, emergency care focuses on stabilizing vital signs, including blood pressure, heart rate, and oxygen levels. Intensive monitoring in an intensive care unit (ICU) is essential to manage critical aspects of the patient’s condition. If an aneurysm is identified as the cause of the SAH, surgical options such as aneurysm clipping or endovascular coiling may be performed to seal the aneurysm and prevent further bleeding. In some cases, surgery might also be required to remove blood or relieve pressure if there is significant bleeding or brain swelling.

Medications play a key role in managing SAH. Pain management is crucial to address severe headaches and discomfort. Antihypertensives are used to control high blood pressure and reduce the risk of additional bleeding. Anticonvulsants may be prescribed to prevent or manage seizures, which can occur after SAH. To prevent or manage vasospasm, where blood vessels constrict and reduce blood flow to the brain, medications such as calcium channel blockers may be utilized.

Ongoing care includes rehabilitation efforts to support recovery. Physical therapy helps with motor function, strength, and mobility, while occupational therapy assists with daily living activities and functional independence. Speech therapy may be needed if there are issues with speech or cognitive function.

Monitoring and follow-up care are crucial for tracking recovery and detecting complications. Regular imaging, such as CT scans or MRIs, helps monitor for any rebleeding or vasospasm. Long-term care focuses on managing any residual symptoms or complications, including cognitive, motor, or psychological issues. Addressing risk factors such as hypertension, smoking, and alcohol use is important for preventing future problems. Additionally, psychosocial support and counseling may be beneficial for emotional and psychological well-being.

Each treatment plan is tailored to the individual based on the severity of the SAH, its underlying cause, and specific health needs, with prompt and effective management being critical for improving outcomes and minimizing long-term complications.