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What is a subarachnoid hemorrhage? — A subarachnoid hemorrhage is a type of stroke that causes bleeding around the brain. "Hemorrhage" is the medical term for bleeding.
For a subarachnoid hemorrhage, the bleeding happens in a part of the head called the "subarachnoid space." This is the area between the brain and the thin layer of tissue that covers it (figure 1).
A bad fall or injury to the head can cause subarachnoid hemorrhage. Another common cause is a bulging blood vessel that bursts. The medical term for this is a "ruptured aneurysm."
A subarachnoid hemorrhage is life-threatening, especially when it is caused by a ruptured aneurysm. Many people who have a subarachnoid hemorrhage die from it.
What are the symptoms of a subarachnoid hemorrhage? — The main symptom is sudden and very painful headache. It can feel like the worst headache you ever had.
Other symptoms include:
●Passing out
●Having a seizure
●Nausea or vomiting
●Stiff neck
●Being bothered by bright light
Is there a test for subarachnoid hemorrhage? — Yes. If your doctor suspects that you had a subarachnoid hemorrhage, they can order 1 or more of these tests:
●CT scan of the head – This is an imaging test that takes pictures of the inside of the head. If there is bleeding around the brain, a CT scan will likely show it.
●Lumbar puncture (sometimes called a "spinal tap") – During this procedure, a doctor puts a needle into the lower back and takes out a small sample of spinal fluid. Spinal fluid is found in the subarachnoid space and surrounds the brain and spinal cord. If this fluid has more red blood cells than usual, you could have a subarachnoid hemorrhage. This test is done if the CT scan does not show bleeding, but your doctor still thinks that you might have a subarachnoid hemorrhage.
●Other imaging tests – If the CT scan or lumbar puncture shows a subarachnoid hemorrhage, your doctor might do other tests to see if the cause is a ruptured aneurysm. These tests include:
•CT angiography (often called "CTA") or magnetic resonance angiography (often called "MRA") – These tests use special types of CT and MRI scans to create pictures of the blood vessels in the brain. Doctors use a dye injection in CTA, and sometimes in MRA. The dye is a chemical that makes blood vessels show up on the test more clearly.
•Catheter angiography – For this test, the doctor puts a thin tube into a large artery in the leg. Then, the doctor moves the tube into the large blood vessels that carry blood to the head. The doctor injects a dye into the tube that shows up on an X-ray. The dye can show problems with the blood vessels in the brain.
How is a subarachnoid hemorrhage treated? — Most people who have a subarachnoid hemorrhage go to the intensive care unit ("ICU") of a hospital for treatment. In the hospital, the doctor might:
●Give medicines and other treatments to reduce the brain damage caused by the bleeding
●Give medicines to lower blood pressure if it is too high
●Stop "anticoagulant" and "antiplatelet" medicines. These include aspirin, warfarin (brand name: Jantoven), and similar medicines that are used to prevent or treat blood clots. If you take any of these medicines, your doctor might give you treatments to help your blood clot. This can help stop bleeding.
●Do tests to figure out the cause of the bleeding
●Watch the pressure in your brain to make sure that it does not get too high
If an aneurysm caused the subarachnoid hemorrhage, doctors must do surgery or another procedure to keep the bleeding from happening again. Depending on the size and location of the aneurysm, they might:
●Put tiny coils in the aneurysm. (This is done during a catheter angiography procedure.)
●Do surgery to put a small clip on the aneurysm.
After a subarachnoid hemorrhage, most people stay in the ICU for a few days, weeks, or sometimes longer. Doctors and nurses watch for problems such as:
●Irregular heartbeat
●Seizures
●Blood clots in the legs
●Lung infections
●Electrolytes that are out of balance – Electrolytes are chemicals in the body that must be present in the right amounts for your body to work correctly.
●Vasospasm – This is a medical term for when the arteries in the brain spasm, causing them to suddenly get narrower. This can happen in the first few days and weeks after a subarachnoid hemorrhage. It can lead to a stroke.
What will my life be like? — A subarachnoid hemorrhage is very serious. Many people die from this type of stroke. Many people who survive, but not all, have long-lasting health problems afterward.
People who have severe subarachnoid hemorrhages can have certain health problems later, such as:
●Memory problems
●Mood changes or problems with emotions
●Thinking problems
●Trouble speaking, walking, or doing other activities
For some people, these problems can be disabling. Other people might not have these problems, or have them only mildly.
Patient education: Stroke (The Basics)
Patient education: Intracerebral hemorrhage (The Basics)
Patient education: Brain aneurysm (The Basics)
Patient education: Hemorrhagic stroke treatment (Beyond the Basics)
Patient education: Stroke symptoms and diagnosis (Beyond the Basics)
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