Subarachnoid Hemorrhage

Understanding Subarachnoid Hemorrhage

A subarachnoid hemorrhage refers to the occurrence of bleeding within the space that surrounds the brain, known as the subarachnoid space. The predominant and often alarming symptom associated with this condition is the abrupt onset of an intensely severe headache, often described as the most excruciating headache one can endure. Additionally, individuals experiencing a subarachnoid hemorrhage may also manifest various other symptoms, including:

Nausea
Vomiting
Stiffness in the neck
Visual disturbances
Brief episodes of unconsciousness

The source of this bleeding typically stems from the rupture of an irregularly bulging blood vessel, known as an aneurysm, within the brain. On occasion, such bleeding may result from traumatic injury, the presence of a complex network of blood vessels in the brain (arteriovenous malformation), or other underlying vascular or medical conditions.

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Diagnosis

To diagnose a subarachnoid hemorrhage, your healthcare provider will typically suggest the following diagnostic tests:

CT Scan

This imaging procedure is highly effective in detecting brain bleeding. However, it’s important to note that a CT scan may not detect the bleed if you have a low red blood cell count (anemia) and only a small amount of blood has been lost during the hemorrhage. To enhance the visibility of your blood vessels and obtain more detailed images, your doctor may inject a contrast dye, a technique known as CT angiogram.

MRI

Another imaging test that can identify brain bleeding is the MRI. In some cases, your healthcare provider may administer a dye into a blood vessel (MR angiogram) to provide a more detailed view of arteries, veins, and blood flow. This approach may be necessary when signs of a subarachnoid hemorrhage are not evident on a CT scan, albeit this occurrence is rare.

Cerebral Angiography

This procedure involves the insertion of a slender catheter into an artery, which is then guided to the brain. Dye is injected into the brain’s blood vessels, rendering them visible under X-ray imaging. Cerebral angiography may be recommended for more detailed images of the blood vessels. It can also be advised if there is suspicion of a subarachnoid hemorrhage, but the cause remains unclear or does not show up on other imaging studies. In some cases, a second cerebral angiogram might be required if the initial one did not reveal an aneurysm, but your healthcare provider believes that an aneurysm is still likely.

In certain instances, particularly with aneurysmal subarachnoid hemorrhages, initial imaging may fail to detect the bleeding. If your first CT scan does not reveal any bleeding, your doctor may suggest a lumbar puncture. During this procedure, a needle is inserted into the lower back to withdraw a small sample of cerebrospinal fluid that surrounds the brain and spinal cord. This fluid is then examined for the presence of blood, which could indicate a subarachnoid hemorrhage.

Treatment

Treatment for a subarachnoid hemorrhage is multifaceted, aiming to stabilize your condition, address any underlying aneurysms, and mitigate potential complications. Here’s an overview of the treatment options and considerations:

Medical Assessment

Your healthcare provider will closely monitor vital signs such as breathing, blood pressure, and blood flow to ensure stability.

Treatment for Aneurysm Rupture

Surgery: If the bleeding is due to a ruptured brain aneurysm, surgical intervention may be recommended. A surgeon will make an incision in the scalp to access the aneurysm and place a metal clip on it to halt blood flow.
Endovascular Embolization: This less invasive procedure involves the insertion of a catheter into an artery, which is threaded to the brain. Detachable platinum coils are guided through the catheter into the aneurysm, reducing blood flow into the sac and inducing clot formation. Advanced techniques such as stent-assisted or balloon-assisted coiling may also be employed for certain aneurysms.
Other Endovascular Treatments: Some aneurysms may be treated with newer endovascular techniques, including devices that divert blood flow away from the aneurysm.

Complication Prevention:

Preventing complications is crucial, as re-bleeding, impaired brain blood flow, electrolyte imbalances (e.g., low sodium), excessive brain fluid accumulation, and fluctuations in blood sugar levels are potential risks.

The medication nimodipine (Nymalize) is often prescribed to reduce circulation problems in the brain following a subarachnoid hemorrhage.

Delayed Vasospasm: Delayed spasm of brain blood vessels is a common complication that can lead to stroke if blood flow decreases significantly. Intravenous medications may be administered to elevate blood pressure or medications can be used to dilate the brain’s blood vessels when this complication arises.
Hydrocephalus: Accumulation of fluid within the brain spaces, known as hydrocephalus, is another common complication. It can be managed with the placement of drains either in the head (ventriculostomy catheter) or lower back (lumbar drains).

Ongoing Care and Follow-Up

Procedures may need to be repeated, and you’ll have regular follow-up appointments with your healthcare provider to monitor your condition for any changes. Additionally, you may require physical, occupational, and speech therapy to aid in your recovery.

The treatment plan will be tailored to your specific condition and needs, with the goal of optimizing recovery and minimizing potential complications.