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A subarachnoid haemorrhage involves bleeding in the space between the brain and the thin layering over the brain. The space is called the subarachnoid space. Causes of a subarachnoid bleed include having a bleeding disorder, bleeding from an arteriovenous malformation, bleeding from a cerebral aneurysm, having a head injury or using blood thinners. It is a common disease in the elderly who fall and strike their head. Among the youth, car accidents make up the greatest cause of a subarachnoid haemorrhage.
The risks of subarachnoid haemorrhage include having a brain aneurysm, having fibromuscular dysplasia or other connective tissue diseases, having high blood pressure, a smoking history, or a history of polycystic kidney disease. People with a strong family history of aneurysms run an increased risk of subarachnoid haemorrhage.
The main symptom of a subarachnoid haemorrhage is a sudden severe headache, worse in the back of the head. It is unlike any other type of headache pain. Other symptoms include having a decreased level of consciousness, problems seeing bright lights, mood changes and personality changes, muscle aches, especially in the neck and shoulder, nausea and vomiting. There can be numbness in parts of the body, a stiff neck, the sudden onset of seizures and visual defects or problems. The pupils can be of different size and there can be an arching of the back called opisthotonos.
Doctors need to waste no time in diagnosing this condition. An examination may show a stiff neck and a stiff back. There can be a focal neurological deficit and decreased eye movements. A head CT should be done quickly and should be done without contrast. If the scan is normal because there has been a small bleed, a lumbar puncture might show blood in the subarachnoid space. Cerebral angiography can be done or a CT scan angiography. A transcranial ultrasound can look at the blood low within the brain’s arteries. MRI and MRI angiography are occasionally done.
In treating a subarachnoid haemorrhage, surgery can be done to relieve the pressure on the brain if there is a large haemorrhage. Surgery can repair an aneurysm if this is the cause of the subarachnoid haemorrhage. If the patient is critically ill, things like surgery might have to be delayed until the individual is more stable.
The surgeon may cut a hole in the skull in order to clip the aneurysm causing the bleed. In addition, endovascular coiling can be done to place a clot inside an aneurysm so it doesn’t bleed any more.
If the individual needs life supportive measures, a tube is placed in the brain to relieve the pressure. In addition to life support, there should be special positioning of the head and body and the airway should be protected at all times. If these things are not done or are done improperly, the patient may die.
Treatment might include medications by IV to control blood pressure, mannitol to decrease pressure on the brain, nimodipine to decrease arterial spasms, painkillers and medications for anxiety, anti-seizure medications, and stool softeners to prevent straining with stooling.
The outlook depends on a number of factors when a person has a subarachnoid haemorrhage:
Possible complications include repeated bleeding, which carries a significantly poor prognosis. Other complications include alterations in level of consciousness, which can lead to significant coma or death, surgical complications, side effects of the medications, stroke or seizure disorders.
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