SUBARACHNOID HEMORRHAGE

General Information

DEFINITION--Sudden bleeding into the subarachnoid space (the area between 2 of the membranes that cover the brain). The space is normally filled with cerebrospinal fluid.

BODY PARTS INVOLVED--Brain; meninges (membranes that cover the brain); blood vessels to the brain.

SEX OR AGE MOST AFFECTED--All ages, but most common in adults aged 25 to 50.

SIGNS & SYMPTOMS

• Acute, severe headache, often followed by unconsciousness.
• Drowsiness, dizziness, convulsions or coma.
• Eye pain with extreme sensitivity to light.
• Vomiting.
• Rapid heartbeat and breathing.
• Stiff neck with pain on movement.
• Fever.
• Numbness, weakness or inability to move an arm or leg.

CAUSES

• Head injury (the most common cause).
• Hardening of the arteries.
• Infection in any part of the central nervous system.
• Rupture of an aneurysm (weakened part of an artery) that has been present since birth. Rupture is often preceded by high blood pressure or hardening of the arteries.
• Bleeding disorder, such as sickle-cell anemia, leukemia or any bleeding that is a side effect of prescription drugs.

RISK INCREASES WITH

• Atherosclerosis (hardening of the arteries) or high blood pressure.
• Family history of bleeding disorders.
• Cerebral aneurysms (run in families).
• Polycystic disease of the kidneys.

HOW TO PREVENT

• Avoid head injury. Use seat belts in cars, protective head gear in contact sports and helmets while biking.
• Obtain medical treatment for an existing aneurysm or arteriovenous malformation.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory studies of blood and cerebrospinal fluid.
• X-rays of the skull.
• CT scan and myelography (See Glossary for both).

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Surgery to stop bleeding and remove collected blood.
• Hospitalization required with treatment directed toward preventing complications.
• Surgery to stop bleeding and remove collected blood.

POSSIBLE COMPLICATIONS--Death or permanent disability. Early diagnosis and treatment can influence outcome.

PROBABLE OUTCOME--If surgery is possible, recovery chances are good. Partial paralysis, weakness or numbness, and speech and visual difficulties may remain in some cases. The damaged area of the brain cannot be restored. However, undamaged areas of the brain often can be taught the lost functions. This usually requires rehabilitation, including physical therapy, occupational therapy or speech therapy. Determination and a positive attitude greatly affect the success of the rehabilitation process.

How To Treat

GENERAL MEASURES--

• Once the acute period of a subarachnoid hemorrhage is over, the follow-up care will depend on the degree of disability. The patient and the family should be involved in the aspects of rehabilitation that are planned by the doctor and the medical support team.
• Ongoing care may be provided at home or the patient may need to be cared for in an extended care facility.

MEDICATION--Your doctor may prescribe cortisone drugs to reduce brain swelling and pressure.

ACTIVITY--

• Strict bed rest until source of hemorrhage is eliminated.
• Following treatment, if you have lost some motor functions, occupational and physical therapists will help you use the affected limbs to regain basic skills, such as eating, dressing and toilet functions.
• After recovery, resume as many of your former activities as your strength and sense of well-being allow. Allow 6 to 12 months for recovery.

DIET--As tolerated at first. May require feeding tube or intravenous feedings.

Call Your Doctor If

• You have any symptoms of a subarachnoid hemorrhage. This is an emergency!
• Symptoms recur after surgery.