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Subarachnoid Hemorrhage

Subarachnoid Hemorrhage

Subarachnoid hemorrhage is a medical emergency caused due to the rupture of blood vessels in the brain. It can be either traumatic or spontaneous. More on it in this write-up.
Ningthoujam Sandhyarani
Last Updated: Mar 19, 2018
Subarachnoid hemorrhage (SAH) is a severe condition in which there is bleeding in the subarachnoid space, the area between the brain and the thin tissues surrounding it. Eventually, that area of the skull surrounding the brain is filled with blood. It is considered as a type of stroke, comprising more than 5 percent of the total stroke cases. Though subarachnoid hemorrhage can occur at any age, it is most common in the age group of 40 - 65. It is also observed that women are at higher risk than men.
Causes and Symptoms
Based on the causes, subarachnoid hemorrhage is classified into two categories―traumatic and spontaneous. The former refers to traumatic head injury and/or brain injury. The latter occurs with or without any warning signs. Most cases are due to the rupture of a cerebral aneurysm, which is an abnormal widening in the arteries of the brain. An individual may have many cerebral aneurysms that may be present at birth, or it can also develop spontaneously.
Other than cerebral aneurysms, spontaneous subarachnoid hemorrhage can be caused by arteriovenous malformation (connection of arteries and veins in the brain), bleeding disorder, the use of blood thinners, and other unknown reasons. Risk factors include smoking, aneurysm problems, weakened blood vessels, high blood pressure, and a family history of cerebral aneurysm and/or polycystic kidney disease.
An affected individual suffers from intense headaches, especially at the rear portion of the head. Other common symptoms are vomiting, confusion, movement difficulty, stiff neck or neck pain, shoulder pain, muscle pain, photophobia (sensitivity to light), and vision problems. In severe cases, these symptoms may be accompanied by seizures.
Diagnosis and Treatment
Diagnosis is done by a physical and neurological examination of the patient. In order to rule out other health conditions, the doctor may conduct a CT (computed tomography) scan or an MRI (magnetic resonance imaging) of the head portion and/or lumbar puncture (collecting cerebrospinal fluid by inserting a spinal needle in the lumbar portion). At times, individuals with this problem show normal CT scan or MRI results. In such a condition, a lumbar puncture is a mandatory procedure for diagnosing the condition. An affected individual will have blood in the cerebrospinal fluid.
Initial treatment is focused on stabilizing the patient and managing the symptoms. Depending upon the severity of the patient's condition, treatment may include intubation, intravenous fluids, and supply of external oxygen. For managing seizures, the patient should be administered with anticonvulsant medications. As per requirement, the doctor may prescribe over-the-counter painkillers and other medications. There should be close examination for any vital changes.
As soon as the patient is stabilized, the physician may conduct certain procedures to detect the source of rupture and other medical complications. Further treatment procedures are based on the location and type of the damaged blood vessel. In general, surgical clip ligation is followed for cerebral aneurysms; whereas, for managing arteriovenous malformation, surgical excision and/or radiosurgery are effective treatment methods.
Immediate medical attention is necessary for treating subarachnoid hemorrhage. It is estimated that about 10 - 15 percent of patients die without receiving proper medical aid. Even those patients who receive medical attention may suffer from neurological impairment.