Part UT Health San Antonio

Subarachnoid Hemorrhage

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

by Cynthia M. Johnson, MA
Definition
Causes
Risk Factors
Symptoms
Diagnosis
Treatment
Prevention

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