Subarachnoid hemorrhage (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.; Varun Kumar, M.B.B.S.

Overview
The subarachnoid space is the area between the brain and the skull and it is normally filled with cerebrospinal fluid (CSF) which can protect the brain. Subarachnoid hemorrhage is a serious, life-threatening type of bleeding in this area. It often occurs without warning. The most common causes of subarachnoid hemorrhage are cerebral arteriovenous malformation and cerebral aneurysm. Headache is the main symptom. It often starts suddenly and starts after a popping or snapping feeling in the head. Other symptoms include speech disturbance, weakness on one side of the body, numbness, neck pain, nausea and vomiting, even sudden or decreased consciousness. Medical history and head images such as CT, MRI and MRA, even lumbar puncture may help diagnosis. Treatment for subarachnoid hemorrhage depends on the underlying cause of the bleeding and the extent of damage to the brain. The goal of treatment is to save the paptient's life, stop the bleeding and damage to the brain, relieve symptoms, and prevent complications and reduce the risk of recurrence. Part patients need long-time recovery and rehabilitation. Prognosis of subarachnoid hemorrhage varies from person to person, depending on the location and extent of the bleeding, and complications.

What are the symptoms of Subarachnoid hemorrhage?

 * Severe headache: Headache is the main symptom. It often starts suddenly and starts after a popping or snapping feeling in the head.
 * Speech disturbance
 * Weakness on one side of the body
 * Numbness
 * Neck pain
 * Double vision
 * Nausea and vomiting
 * Sudden or decreased consciousness
 * Personality changes such as confusion and irritability

Who is at highest risk?

 * Cerebral arteriovenous malformation
 * Cerebral aneurysm
 * Head injury
 * Polycystic kidney disease
 * Hypertension
 * Smoking
 * Idiopathic

When to seek urgent medical care?
Go to emergency department or call 911 as soon as possible when you feel severe headache.

Diseases with similar symptoms

 * Stroke
 * Encephalitis
 * Meningitis
 * Migraine

Diagnosis

 * Medical history, physical examination and neurological examation
 * Head noncontrast CT: Head CT may show evidence of aneurism and hemorrhage area. In some cases, CT scan may be normal.
 * Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA): These images are occasionally used to diagnose a subarachnoid hemorrhage or find other associated conditions.
 * Cerebral angiography: This test can show small aneurysms or other vascular problems. It can locate the exact point of the bleed and can tell whether there is blood vessel spasm or not.
 * Lumbar puncture: When your severe headache is suspected subarachnoid hemorrhage but head CT shows normal, the doctor may order this test. During this procedure, the patient lies on the side, with knees pulled up toward the chest, and chin tucked downward. After injecting the anesthetic into the lower spine, the doctor insert a spinal needle into the lower back area to measure CSF pressure and collect a sample. Patients with subarachnoid hemorrhage will have blood in the spinal fluid.

Treatment options
Treatment for subarachnoid hemorrhage depends on the underlying cause of the bleeding and the extent of damage to the brain. The goal of treatment is to save the paptient's life, stop the bleeding and damage to the brain, relieve symptoms, and prevent complications and reduce the risk of recurrence.
 * Absolute bedrest and close monitoring of vital signs. During the three weeks immediately following the hemorrhage, it is very important since the complications and rerupture are most likely to occur.
 * Intubation and mechanical ventilation, supplemental oxygen and intravenous fluids.
 * Surgery: If the subarachnoid hemorrhage is caused by a ruptured aneurysm or a trauma. Surgery may be performed to stop the bleeding and repair the injury.
 * Medications: Medications may be used to prevent seizures, relieve headache, control blood pressure and aid relaxation.
 * Recovery and rehabilitation: The physiatrist will help you recover the skills you may have lost, such as walking, communicating, or keeping balance or coordination. The rehabilitation is very important because the effect of rehabilitation determines the life quality of you and your family in the furture.

Where to find medical care for Subarachnoid hemorrhage?
Directions to Hospitals Treating Subarachnoid hemorrhage

What to expect (Outlook/Prognosis)?
Prognosis of subarachnoid hemorrhage depends on:
 * The location and extent of the bleeding
 * Whether the patient is accompanied with any complications, such as stroke and seizures.
 * Severity of symptoms from the beginning
 * The patient's general condition

Prevention

 * Prevent head trauma
 * Identify and treat cerebral arteriovenous malformation or cerebral aneurysm