Carl R. Darnall Army Medical Center - Health Library

Subarachnoid Hemorrhage

Pronounced: sub-a-RACK-noid HEM-o-ridge

Definition

Subarachnoid hemorrhage (SAH) is a type of stroke that happens when a blood vessel breaks. Blood quickly fills the site around the brain and spinal cord. This space has fluid that cushions and protects the brain and spinal cord.

SAH is a threat to life. Emergency care is needed. SAH may raise the pressure around the brain. It can get in the way of how the brain works.

Causes ^

SAH may be caused by:

Risk Factors ^

You risk may be higher with:

Symptoms ^

Symptoms may include:

  • A very sudden, severe headache
  • Seizures
  • Confusion

If you have these symptoms, call for emergency medical services right away. Early care can lower the amount of harm to the brain.

Diagnosis ^

Your doctor will ask about your symptoms and health history. A physical exam will be done.

The fluid in your spine may need to be tested. This can be done with a lumbar puncture.

Pictures may be taken of the brain and the structures around it. This can be done with:

CT Scan of the Head

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Treatment ^

SAH is a serious problem. You will need to be treated in the intensive care unit. Despite treatment, many people with SAH die.

The goals of treatment are to:

  • Stop the bleeding
  • Limit harm to the brain
  • Reduce the risk of another SAH

Treatment options include:

  • Surgery to place a tube in the blood vessels going to the brain
  • Medicine to help blood flow to the brain
  • Bed rest to prevent more bleeding

Once you are stable, you will need to be in a rehabilitation program.

Prevention ^

Aneurysms present from birth can’t be prevented. Because they are so rare, doctors don’t advise screening for them. If an unruptured aneurysm is found by chance in a young person, the doctor may do surgery.

To lower your chance of SAH:

  • Avoid smoking.
  • Control high blood pressure.
  • Eat a healthy diet.
RESOURCES:

The Brain Aneurysm Foundation
http://www.bafound.org

National Stroke Association
http://www.stroke.org

CANADIAN RESOURCES:

Brain Injury Canada
http://braininjurycanada.ca

Heart & Stroke Foundation
http://www.heartandstroke.com

REFERENCES:

Awad I. The riddle of association, causation, and prevention of subarachnoid hemorrhage. J Neurol Neurosurg Psych. 2012;83(11):1035.

Awad IA. When blood tickles the brain: Where is the argument? World Neurosurg. 2013;79(5-6):636-637.

Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: A guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38(6):2001-2023.

Feigin V, Parag V, et al. Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the Asia-pacific region: An overview of 26 cohorts involving 306,620 participants. Stroke. 2005;36(7):1360-1365.

Feigin VL, Rinkel GJ, Lawes CM, et al. Risk factors for subarachnoid hemorrhage: An updated systematic review of epidemiological studies. Stroke. 2005;36(12):2773-3780.

Ingall T, Asplund K, Mähönen M, Bonita R. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke. 2000;31(5):1054-1061.

Jabbour PM, Tjoumakaris SI, Rosenwasser RH. Endovascular management of intracranial aneurysms. Neurosurg Clin N Amer. 2009;20(4):383-398.

Bederson JB, Connolly ES Jr, Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 2009;40(3):994-1025.

Stroke rehabilitation. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T580145/Stroke-rehabilitation. Updated March 23, 2018. Accessed June 25, 2018.

Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354(4):387-396.

Subarachnoid hemorrhage. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116453/Subarachnoid-hemorrhage. Updated June 6, 2018. Accessed June 25, 2018.

van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007;269(9558):306-318.

Last reviewed June 2018 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated: 6/25/2018