Subarachnoid hemorrhage

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.

Alternative Names

Hemorrhage - subarachnoid

Causes

Subarachnoid hemorrhage can be caused by:

Subarachnoid hemorrhage caused by injury 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.

Risks include:

A strong family history of aneurysms may also increase your risk.

Symptoms

The main symptom is a severe headache that starts suddenly (often called thunderclap headache). It is often worse near the back of the head. Many persons 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:

Other symptoms that may occur with this disease:

Exams and Tests

Signs include:

If your doctor thinks you have a subarachnoid hemorrhage, a head CT scan (without contrast dye) will be done right away. In some cases, the scan is normal, especially if there is only been a small bleed. If the CT scan is normal, a lumbar puncture (spinal tap) must be done.

Other tests that may be done include:

Treatment

The goals of treatment are to:

Surgery may be done to:

If the patient is critically ill, surgery may have to wait until the person is more stable.

Surgery may involve:

If no aneurysm is found, the person should be closely watched by a health care team and may need more imaging tests.

Treatment for coma or decreased alertness includes:

A person who is is conscious may need to be on strict bed rest. The person will be told to avoid activities that can increase pressure inside the head, including:

Treatment may also include:

Outlook (Prognosis)

How well a patient with subarachnoid hemorrhage does depends on a number of different factors, including:

Older age and more severe symptoms can lead to a poorer outcome.

People can recover completely after treatment. But some people die even with treatment.

Possible Complications

Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is much worse.

Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.

Other complications include:

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of a subarachnoid hemorrhage.

Prevention

Identifying and successfully treating an aneurysm can prevent subarachnoid hemorrhage.

References

Naggara ON, White PM, Guilbert F, et al. Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology. 2010;256:887-897.

Reinhardt MR. Subarachnoid hemorrhoid. J Emerg Nurs. 2010;36:327-329.

Tateshima S, Duckwiler G. Vascular diseases of the nervous system: intracranial aneurysms and subarachnoid hemorrhage. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 51C.

Zivin J. Hemorrhagic cerebrovascular disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 415.