Subarachnoid haemorrhage awareness

Overview

A subarachnoid haemorrhage is a type of stroke caused by bleeding in the space surrounding the brain. It is a medical emergency that requires immediate treatment.

Subarachnoid haemorrhage is not common, affecting about 6 to 10 people per 100,000 each year.

It can affect anyone, but is more common in people aged 40 to 60 and slightly more common in women. Certain risk factors like high blood pressure and smoking increase the chance.

Symptoms

Common symptoms

• Sudden, severe headache (often called a 'thunderclap' headache)
• Neck stiffness
• Nausea and vomiting
• Sensitivity to light (photophobia)
• Blurred or double vision
• Loss of consciousness or confusion

Symptoms in children

• Subarachnoid haemorrhage is rare in children, but symptoms may include sudden severe headache, vomiting, and irritability.

Symptoms in older adults

• Older adults may experience confusion, drowsiness, or a less severe headache that still requires medical attention.

Causes

Main causes

• Most commonly a ruptured aneurysm (a bulging weak spot on a blood vessel in the brain)
• Other causes include head injury, an arteriovenous malformation (a tangle of abnormal blood vessels), or a bleeding disorder

Risk factors

• High blood pressure
• Smoking
• Excessive alcohol intake
• Family history of brain aneurysms
• Certain connective tissue disorders (such as Ehlers-Danlos syndrome)

When to see a doctor

See a doctor urgently if:

• Seek emergency medical help immediately if you have a sudden, very severe headache – especially if it is the worst headache of your life.

Book a routine appointment if:

• If you have a family history of brain aneurysms, talk to your GP about whether screening might be right for you.

Diagnosis

A doctor will take a history and perform a neurological exam. If subarachnoid haemorrhage is suspected, immediate brain imaging is done.

Tests that may be done

• CT scan (computed tomography) of the head – this can often show bleeding
• Lumbar puncture (spinal tap) – if the CT scan is normal but suspicion remains, a sample of fluid around the spine is taken to check for blood
• Angiography (CT or MRI) – to find the exact source of bleeding, such as an aneurysm

What to expect at your appointment

You will be admitted to hospital, often to a specialist neurosciences unit, for urgent tests and close monitoring. The process can be frightening, but the medical team will explain each step.

Treatment

Treatment focuses on stopping the bleeding, preventing further bleeding, and managing complications. This usually starts in the emergency department and continues in a specialist hospital unit.

Self-care at home

• Do not try to treat this condition at home – emergency medical care is essential.
• During recovery, rest and avoid straining (for example, avoid heavy lifting or constipation).

Medical treatments

Medications may be given to control blood pressure, prevent blood vessel narrowing (vasospasm), and manage pain. Procedures to seal the bleeding aneurysm – such as coiling (threading a small device through blood vessels) or clipping (surgical placement of a tiny clip at the aneurysm base) – are often performed.

When is surgery considered?

Surgery (clipping) or an endovascular procedure (coiling) is usually needed to treat the aneurysm and prevent rebleeding. The choice depends on the size, location, and shape of the aneurysm as well as your overall health.

Living with this condition

Recovery from a subarachnoid haemorrhage takes time – often weeks to months. Many people need rehabilitation including physiotherapy, speech and language therapy, and occupational therapy to regain skills and independence.

Lifestyle tips

• Avoid smoking and limit alcohol intake.
• Manage stress with relaxation techniques or counselling.
• Attend all follow-up appointments with your healthcare team.

Diet and exercise

Eat a healthy, balanced diet low in salt to help control blood pressure. Once your doctor says it is safe, gentle exercise such as walking can be beneficial. Always follow the advice of your healthcare team.

Mental health and emotional wellbeing

It is common to feel anxious, depressed, or overwhelmed after a subarachnoid haemorrhage. Do not hesitate to talk to your healthcare team or a mental health professional – support is available.

Prevention

Many cases cannot be prevented, but you can reduce your risk by controlling high blood pressure, not smoking, limiting alcohol, and seeking medical advice if you have a strong family history of aneurysms.

Screening programmes

Screening (imaging tests) may be offered to people with a strong family history of brain aneurysms. Talk to your GP about whether this is appropriate for you.

Complications

If left untreated

• Rebleeding from the aneurysm (which can be fatal)
• Vasospasm (narrowing of brain arteries) leading to stroke-like damage
• Hydrocephalus (build-up of fluid in the brain)
• Long-term neurological problems such as difficulty speaking, moving, or thinking

Long-term outlook

With prompt medical treatment, many people survive and recover. However, subarachnoid haemorrhage is a serious condition – about half of cases are fatal in the first 30 days. Of those who survive, many regain good function, though some have lasting difficulties. Early emergency care greatly improves the chances of a good outcome.

Find support

International organisations

• Brain & Spine Foundation ↗

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