In subarachnoid hemorrhage (SAH), bleeding occurs between the pia mater surrounding the brain and the arachnoid membrane. The condition can lead to severe complications, including stroke and death, and requires immediate medical attention. For managing this life-threatening condition, it is crucial to recognize its causes, diagnose it accurately, and implement effective treatment and prevention strategies.
A subarachnoid hemorrhage is commonly caused by a ruptured intracranial aneurysm, which is a weak area in a blood vessel supplying the brain. Other potential causes include:
Severe head trauma can rupture blood vessels and cause bleeding into the subarachnoid space.
Abnormal connections between arteries and veins in the brain can lead to arteriovenous malformations (AVMs).
Blood vessel walls can become weak and vulnerable to rupture when amyloid protein is deposited in them, causing cerebral amyloid angiopathy.
Blood clotting disorders, such as hemophilia and anticoagulant therapy, can lead to spontaneous bleeding.
Subarachnoid hemorrhage is characterized by sudden, severe headaches often described as the "worst headache of my life." Other symptoms include:
Vomiting and nausea
Neck pain
Light sensitivity (photophobia)
Confusion or altered mental status
Consciousness loss
A seizure
Neurological deficits on one side of the body, such as weakness or numbness
The severity of symptoms can vary greatly among individuals with subarachnoid hemorrhage, and not everyone will experience all of them.
Typically, subarachnoid hemorrhages are diagnosed through a combination of clinical evaluation, imaging studies, and diagnostic tests.
A neurological examination examines the patient's symptoms, mental status, and neurological function.
For the detection and evaluation of subarachnoid hemorrhage, computed tomography (CT) is often the first-line imaging modality. Further evaluation or identification of the underlying cause of bleeding may require magnetic resonance imaging (MRI) or cerebral angiography.
To detect bleeding, a lumbar puncture (spinal tap) may be performed in some cases.
The goal of treating subarachnoid hemorrhage is to stabilize the patient, prevent complications, and address the underlying cause of bleeding. Treatment options may include:
Stroke or neurocritical care hospitalization
Vital signs and neurological status are monitored
The use of medications to control blood pressure, prevent vasospasm, and reduce the risk of complications such as seizures or cerebral edema
Surgical interventions such as coil embolization or surgical clipping of aneurysms to repair or occlude ruptured blood vessels
Providing rehabilitation therapy to promote recovery and improve functional outcomes
Healthy lifestyle habits and addressing modifiable risk factors are key to preventing subarachnoid hemorrhage.
Controlling hypertension is essential for reducing the risk of aneurysm rupture and subsequent hemorrhaging.
Tobacco use is a significant risk factor for the development and rupture of intracranial aneurysms.
Consuming excessive alcohol can increase blood pressure and predispose individuals to bleeding disorders.
Prompt evaluation and treatment of traumatic head injuries can prevent complications such as bleeding into the subarachnoid space.
