Subarachnoid Haemorrhage

Overview

A subarachnoid haemorrhage is a type of bleeding in the space between the brain and the thin covering over it. This bleeding can raise pressure inside the skull and damage the brain. It is a medical emergency.

No, it is not common. It accounts for about 1 in every 20 strokes, but it can be life-threatening.

It can happen at any age, but it is more common between ages 40 and 60. Women are affected slightly more often than men.

Symptoms

Common symptoms

• Sudden, severe headache (often called a thunderclap headache)
• Stiff neck
• Feeling or being sick
• Sensitivity to light
• Blurred or double vision
• Confusion, drowsiness, or trouble speaking
• Seizure with loss of consciousness

Symptoms in children

• Children may have the same symptoms but may not be able to describe them.
• They may suddenly cry, vomit, have a stiff neck, become very sleepy, or have a seizure.
• If this happens, call emergency services immediately.

Symptoms in older adults

• Older adults may not have a severe headache.
• Instead, they might become confused, dizzy, or have a sudden fall.
• These signs also need urgent medical attention.

Causes

Main causes

• A burst aneurysm (a bulge in a blood vessel in the brain)
• A head injury
• In some cases, the cause is unknown

Risk factors

• High blood pressure
• Smoking
• Drinking a lot of alcohol
• A family history of brain aneurysms
• Some inherited conditions that weaken blood vessel walls

When to see a doctor

See a doctor urgently if:

• Call emergency services right away if you have a sudden, severe headache or any of the emergency symptoms listed above.
• If someone has a seizure or cannot be woken up, call emergency services immediately.

Book a routine appointment if:

• If you have frequent headaches or a family history of brain aneurysms, talk to your doctor about whether you need any checks.

Diagnosis

A doctor will examine you and ask about your symptoms. You will usually go to a hospital emergency department for immediate tests.

Tests that may be done

• CT scan (a detailed X-ray of the brain)
• Lumbar puncture (a small sample of fluid is taken from around the spine)
• CT angiogram or MRI scan to look at the brain's blood vessels

What to expect at your appointment

The tests are quick. If a subarachnoid haemorrhage is found, you will be admitted to the hospital for close observation and treatment.

Treatment

Treatment aims to stop the bleeding, ease pressure on the brain, and prevent complications. You may stay in an intensive care unit for part of your care.

Self-care at home

• While in the hospital, follow your care team's advice and rest as much as possible.
• At home, gradually build up activities and avoid heavy lifting until your doctor says it is safe.
• Go to all follow-up appointments and take any medicines exactly as your doctor recommends.

Medical treatments

Doctors may use medicines to control blood pressure, prevent seizures, or reduce blood vessel spasm. They may also give oxygen or other supportive treatments. Always ask your doctor or pharmacist if you have questions about your medicines.

When is surgery considered?

Some people need a procedure to stop blood from reaching the aneurysm. This can be done with a small metal clip placed during open surgery or with tiny coils placed inside the aneurysm using a thin tube. The choice depends on the aneurysm's size, location, and your overall health.

Living with this condition

Recovery can take weeks or months. You may feel tired, have headaches, or find it hard to concentrate. Most people need to take time off work and avoid driving for a while.

Lifestyle tips

• Ask your doctor before driving, returning to work, or doing physical activities.
• Keep your follow-up appointments and get support from your healthcare team.
• Avoid smoking and limit alcohol to help protect your blood vessels.

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, and whole grains. Keep your blood pressure in a healthy range and ask your doctor what level of exercise is safe for you.

Mental health and emotional wellbeing

Going through a subarachnoid haemorrhage can be stressful and frightening. You may feel anxious, irritable, or sad. These feelings are normal, and talking to loved ones, a counsellor, or your doctor can help.

Prevention

Not always, but there are things you can do to lower your risk: control high blood pressure, don't smoke, limit alcohol, and manage any health conditions that affect your blood vessels.

Vaccines

There is no vaccine for subarachnoid haemorrhage.

Screening programmes

There is no routine screening for everyone. If you have a strong family history of brain aneurysms, your doctor may suggest an imaging test to look for aneurysms.

Complications

If left untreated

• Brain damage from increased pressure in the skull
• A second, more serious bleed
• A stroke
• Long-term disability or death

Long-term outlook

The outlook is serious, but many people do recover. It depends on how severe the bleed is, how quickly treatment starts, and your general health. Your care team will be honest with you about what to expect and will support you through recovery.

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