Subarachnoid Hemorrhage Overview
Learn About Subarachnoid Hemorrhage
Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space. Subarachnoid bleeding is an emergency and prompt medical attention is needed.
Hemorrhage - subarachnoid; Subarachnoid bleeding
Subarachnoid hemorrhage can be caused by:
- Bleeding from a tangle of blood vessels called an arteriovenous malformation (AVM)
- Bleeding disorder
- Bleeding from a cerebral aneurysm (weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out)
- Head injury
- Unknown cause (idiopathic)
- Use of blood thinners
Subarachnoid hemorrhage caused by head injury in older people is often due to falls. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes. When caused by trauma, subarachnoid hemorrhage commonly occurs with other types of bleeding in the head.
Risks include:
- Unruptured aneurysm in the brain and other blood vessels
- Fibromuscular dysplasia (FMD) and other connective tissue and autoimmune disorders
- High blood pressure
- History of polycystic kidney disease
- Smoking
- Use of illicit drugs such as cocaine and methamphetamine
- Use of blood thinners such as warfarin
A strong family history of aneurysms may also increase your risk.
The main symptom is a severe headache that starts suddenly (often called thunderclap headache). It is often worse near the back of the head. Many people often describe it as the "worst headache ever" and unlike any other type of headache pain. The headache may start after a popping or snapping feeling in the head.
Other symptoms:
- Decreased consciousness and alertness
- Eye discomfort in bright light (photophobia)
- Mood and personality changes, including confusion and irritability
- Muscle aches (especially neck pain and shoulder pain)
- Nausea and vomiting
- Numbness in part of the body
- Seizure
- Stiff neck
- Vision problems, including double vision, blind spots, or temporary vision loss in one eye
Other symptoms that may occur with this disease:
- Eyelid drooping
- Pupil size difference
- Sudden stiffening of back and neck, with arching of the back (opisthotonos; not very common)
The goals of treatment are to:
- Save your life
- Repair the cause of bleeding
- Relieve symptoms
- Prevent complications such as permanent brain damage (stroke)
Surgery may be done to:
- Remove large collections of blood or relieve pressure on the brain if the hemorrhage is due to an injury
- Repair the aneurysm if the hemorrhage is due to an aneurysm rupture
If the person is critically ill, surgery may have to wait until the person is more stable.
Surgery may involve:
- Craniotomy (cutting a hole in the skull) and aneurysm clipping, to close the aneurysm
- Endovascular coiling: placing coils in the aneurysm and stents in the blood vessel to cage the coils reduces the risk of further bleeding
If no aneurysm is found, the person should be closely watched by a health care team and may need more imaging tests.
Treatment for coma or decreased alertness includes:
- Draining tube placed in the brain to relieve pressure
- Life support
- Methods to protect the airway
- Special positioning
- Special medicines to decrease swelling in the skull
A person who is conscious may need to be on strict bed rest. The person will be told to avoid activities that can increase pressure inside the head, including:
- Bending over
- Straining
- Suddenly changing position
Treatment may also include:
- Medicines given through an IV line to control blood pressure
- Medicine to prevent artery spasms
- Painkillers and anti-anxiety medicines to relieve headache
- Medicines to prevent or treat seizures
- Stool softeners or laxatives to prevent straining during bowel movements
- Medicines to prevent seizures
Jefferson University Physicians
Pascal Jabbour is a Neurosurgery provider in Philadelphia, Pennsylvania. Dr. Jabbour and is rated as an Elite provider by MediFind in the treatment of Subarachnoid Hemorrhage. His top areas of expertise are Brain Aneurysm, Stroke, Subarachnoid Hemorrhage, Thrombectomy, and Stent Placement.
Yale University
Charles Matouk is a Neurosurgery specialist and an Interventional Radiologist in New Haven, Connecticut. Dr. Matouk and is rated as an Elite provider by MediFind in the treatment of Subarachnoid Hemorrhage. His top areas of expertise are Stroke, Subarachnoid Hemorrhage, Hydrocephalus, Thrombectomy, and Stent Placement.
Jefferson University Physicians
Stavropoula Tjoumakaris is a Neurosurgery provider in Philadelphia, Pennsylvania. Dr. Tjoumakaris and is rated as an Elite provider by MediFind in the treatment of Subarachnoid Hemorrhage. Their top areas of expertise are Brain Aneurysm, Stroke, Subarachnoid Hemorrhage, Thrombectomy, and Stent Placement.
How well a person with subarachnoid hemorrhage does depends on a number of different factors, including:
- Location and amount of bleeding
- Complications
Older age and more severe symptoms can lead to a poorer outcome.
People can recover completely after treatment. But some people die, even with treatment.
Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is much worse.
Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.
Other complications include:
- Complications of surgery
- Medicine side effects
- Seizures
- Stroke
Go to the emergency room or call 911 or the local emergency number if you or someone you know has symptoms of a subarachnoid hemorrhage.
The following measures may help prevent subarachnoid hemorrhage:
- Stopping smoking
- Treating high blood pressure
- Identifying and successfully treating an aneurysm
- Not using illicit drugs
Summary: Acute lung injury is a common complication of subarachnoid hematoma (SAH), and a significant risk factor for death in patients with SAH. Unlike neurogenic pulmonary edema and pneumonia following brain injury, the clinical causes of pulmonary injury after SAH are not intracranial hypertension or pulmonary infection. Its occurrence is influenced by the release of catecholamines, the regulatory funct...
Summary: Acute hemorrhagic stroke is a series of neurosurgical diseases characterized by bleeding with high morbidity and mortality. It accounts for about 20% of all strokes worldwide and mainly includes subtypes such as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Multimodal computed tomography including non-contrast computed tomography, computed tomography angiography and computed to...
Published Date: January 23, 2023
Published By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Mayer SA. Hemorrhagic cerebrovascular disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 380.
Szeder V, Tateshima S, Jahan R, Saver JL, Duckwiler GR. Intracranial aneurysms and subarachnoid hemorrhage. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 67.