17871 Subarachnoid Hemorrhage Sah

Overview

A subarachnoid hemorrhage (say: sub-uh-RAK-noid HEM-uh-rij) is bleeding in the space between the brain and the thin tissue that covers it. This space is called the subarachnoid space. It is a type of stroke that can be life-threatening and needs immediate medical care.

No, subarachnoid hemorrhage is not very common. It accounts for about 1 in every 20 strokes, but it is very serious.

It can happen to anyone, but it is most common in people between the ages of 45 and 60. Women are affected slightly more often than men. People with high blood pressure, smokers, and those with a family history of brain aneurysms have a higher risk.

Symptoms

Common symptoms

• Sudden, severe headache that comes on like a thunderclap — often called the 'worst headache of your life'
• Nausea and vomiting
• Stiff neck
• Sensitivity to light
• Blurred or double vision
• Confusion or trouble speaking
• Seizures
• Weakness or numbness on one side of the body
• Drooping eyelid or an enlarged pupil in one eye
• Loss of consciousness, even briefly

Symptoms in children

• Subarachnoid hemorrhage is rare in children, but possible signs include irritability, poor feeding, extreme tiredness, and in babies, a bulging soft spot on the skull (fontanelle).

Symptoms in older adults

• In older adults, the classic sudden headache may be less obvious. Instead, they may show confusion, drowsiness, or a sudden change in behavior. Any new neurological symptom should be treated as an emergency.

Causes

Main causes

• A ruptured brain aneurysm — a weak spot in a blood vessel wall that balloons out and bursts
• A head injury
• An arteriovenous malformation (AVM) — an abnormal tangle of blood vessels in the brain
• A bleeding disorder that affects how blood clots
• Certain blood-thinning medications (talk to your doctor about your specific medicines)

Risk factors

• High blood pressure
• Smoking
• Excessive alcohol use
• Illicit drug use, especially cocaine
• Family history of brain aneurysms or subarachnoid hemorrhage
• Some genetic conditions, such as polycystic kidney disease
• Being middle-aged or older, especially 45 to 60
• Being female

When to see a doctor

See a doctor urgently if:

• Any sudden, severe headache — call your local emergency number right away
• Headache accompanied by vomiting, stiff neck, confusion, or weakness
• Headache after a head injury

Book a routine appointment if:

• Frequent headaches that are unusual for you
• High blood pressure that is hard to control
• A family history of brain aneurysm and concerns about your own risk

Diagnosis

A subarachnoid hemorrhage is diagnosed in the emergency department. The doctor will ask about your symptoms, do a physical exam, and order imaging scans of your brain. It is important to get help quickly because the sooner you are diagnosed, the sooner treatment can begin.

Tests that may be done

• CT scan of the head — a special X-ray that can show bleeding in the brain
• Lumbar puncture (spinal tap) — a sample of spinal fluid is taken from your lower back to check for blood
• MRI scan — detailed images of the brain
• CT angiography — a CT scan with contrast dye to look at blood vessels in the brain
• Cerebral angiography — a detailed X-ray of the brain's blood vessels using dye

What to expect at your appointment

You will be seen quickly. The care team will explain what is happening. You may have blood tests, scans, and a spinal tap. If the diagnosis is confirmed, you will be admitted to the hospital, often to an intensive care unit (ICU) or a specialized stroke unit.

Treatment

Treatment starts as an emergency. The main goals are to stop the bleeding, relieve pressure on the brain, prevent re-bleeding, and manage complications. You will be in a hospital, likely in intensive care, where your vital signs are watched closely.

Self-care at home

• While in the hospital, rest quietly — your care team will guide you on how much rest you need
• Avoid straining (such as heavy lifting or forceful coughing) until your doctor says it's safe
• Do not take any new medicines without asking your care team
• After discharge, follow all rehabilitation and check-up appointments

Medical treatments

Doctors may use medicines to control blood pressure, prevent blood vessel spasms (vasospasm), manage pain, prevent seizures, and reduce brain swelling. They may also use treatments to protect the brain and help you recover. You will not be given specific drug names here; your healthcare team will decide what is right for you.

When is surgery considered?

Surgery is often needed to repair the source of bleeding. This can be done by clipping the aneurysm during open surgery, or by endovascular coiling, where a catheter is threaded through a blood vessel to block off the aneurysm. The choice depends on your specific situation and the surgeon's expertise.

Living with this condition

Recovery from a subarachnoid hemorrhage takes time. You may need rehabilitation to help with movement, speech, memory, and daily tasks. Patience is important — progress can be gradual. You will have regular check-ups with your healthcare team.

Lifestyle tips

• Do not smoke — ask your healthcare provider for support to quit
• Limit alcohol to the recommended amounts, or avoid it if your doctor advises
• Manage blood pressure with regular checks and follow your treatment plan
• Avoid activities that involve heavy lifting or straining during recovery
• Get enough sleep and pace yourself during the day

Diet and exercise

A balanced diet low in salt and rich in fruits, vegetables, and whole grains can support blood pressure control. Gentle exercise, like short walks, can be started once your doctor approves. Always ask your rehabilitation team before starting any new exercise.

Mental health and emotional wellbeing

It is normal to feel anxious, depressed, overwhelmed, or frustrated after a subarachnoid hemorrhage. You may also have post-traumatic stress symptoms. Talk to your healthcare team about how you feel — they can provide support and connect you with counselling if needed. If you are having thoughts of self-harm or hopelessness, seek crisis support immediately.

Prevention

You cannot always prevent a subarachnoid hemorrhage, but you can reduce your risk. Control high blood pressure, do not smoke, limit alcohol, avoid recreational drugs, and manage health conditions like diabetes. If you have a family history of brain aneurysms, talk to your doctor about whether any screening is right for you.

Screening programmes

Routine screening for brain aneurysms is not usually recommended. But if you have two or more close family members who have had a brain aneurysm or subarachnoid hemorrhage, your doctor may consider imaging tests. Discuss your personal risk with your healthcare provider.

Complications

If left untreated

• Re-bleeding — a second hemorrhage can be more damaging
• Vasospasm — blood vessels in the brain narrow, reducing blood flow and causing further brain injury
• Hydrocephalus — buildup of fluid in the brain that increases pressure
• Permanent brain damage affecting speech, movement, or memory
• Death

Long-term outlook

With fast emergency treatment, many people survive a subarachnoid hemorrhage. Recovery can take months or longer, but with rehabilitation and support, many people regain much of their function. The outcome depends on how severe the bleeding was, how quickly treatment began, and your overall health. Your care team will work with you to give you the best possible chance of recovery.

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