Also known as: Hemorrhage - subarachnoid
- Bleeding from a tangle of blood vessels called an arteriovenous malformation (AVM)
- Bleeding disorder
- Bleeding from a cerebral aneurysm
- Head injury
- Unknown cause (idiopathic)
- Use of blood thinners
- Aneurysm in other blood vessels
- Fibromuscular dysplasia (FMD) and other connective tissue disorders
- High blood pressure
- History of polycystic kidney disease
- Decreased consciousness and alertness
- Eye discomfort in bright light (photophobia)
- Mood and personality changes, including confusion and irritability
- Muscle aches (especially neck pain and shoulder pain)
- Nausea and vomiting
- Numbness in part of the body
- Stiff neck
- Vision problems, including double vision, blind spots, or temporary vision loss in one eye
- A physical exam may show a stiff neck
- A brain and nervous system exam may show signs of decreased nerve and brain function (focal neurologic deficit)
- An eye exam may show decreased eye movements. A sign of damage to the cranial nerves (in milder cases, no problems may be seen on an eye exam)
- Save your life
- Repair the cause of bleeding
- Relieve symptoms
- Prevent complications such as permanent brain damage (stroke)
- Remove large collections of blood or relieve pressure on the brain if the hemorrhage is due to an injury
- Repair the aneurysm if the hemorrhage is due to an aneurysm rupture
- Craniotomy (cutting a hole in the skull) and aneurysm clipping, to close the aneurysm
- Endovascular coiling, placing coils in the aneurysm and stents in the blood vessel to cage the coils reduces the risk of further bleeding
- Draining tube placed in the brain to relieve pressure
- Life support
- Methods to protect the airway
- Special positioning
- Bending over
- Suddenly changing position
- Medicines given through an IV line to control blood pressure
- Nimodipine to prevent artery spasms
- Painkillers and anti-anxiety medicines to relieve headache and reduce pressure in the skull
- Phenytoin or other medications to prevent or treat seizures
- Stool softeners or laxatives to prevent straining during bowel movements
- Location and amount of bleeding
- Complications of surgery
- Medicine side effects
Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space.
Subarachnoid hemorrhage can be caused by:
Subarachnoid hemorrhage caused by injury is often seen in the elderly who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes.
A strong family history of aneurysms may also increase your risk.
The main symptom is a severe headache that starts suddenly (often called thunderclap headache). It is often worse near the back of the head. Many people often describe it as the "worst headache ever" and unlike any other type of headache pain. The headache may start after a popping or snapping feeling in the head.
Other symptoms that may occur with this disease:
Exams and Tests
If your doctor thinks you have a subarachnoid hemorrhage, a head CT scan (without contrast dye) will be done right away. In some cases, the scan is normal, especially if there has only been a small bleed. If the CT scan is normal, a lumbar puncture (spinal tap) may be done.
Other tests that may be done include:
The goals of treatment are to:
Surgery may be done to:
If the person is critically ill, surgery may have to wait until the person is more stable.
Surgery may involve:
If no aneurysm is found, the person should be closely watched by a health care team and may need more imaging tests.
Treatment for coma or decreased alertness includes:
A person who is conscious may need to be on strict bed rest. The person will be told to avoid activities that can increase pressure inside the head, including:
Treatment may also include:
How well a person with subarachnoid hemorrhage does depends on a number of different factors, including:
Older age and more severe symptoms can lead to a poorer outcome.
People can recover completely after treatment. But some people die even with treatment.
Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is much worse.
Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.
Other complications include:
When to Contact a Medical Professional
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of a subarachnoid hemorrhage.
Identifying and successfully treating an aneurysm can prevent subarachnoid hemorrhage.
Mayer SA. Hemorrhagic cerebrovascular disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 408.
Reinhardt MR. Subarachnoid hemorrhage. J Emerg Nurs. 2010;36:327-329. PMID: 20624566 www.ncbi.nlm.nih.gov/pubmed/20624566.
Tateshima S, Duckwiler G. Vascular diseases of the nervous system: intracranial aneurysms and subarachnoid hemorrhage. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 51C.
- Review date:
- March 02, 2015
- Reviewed by:
- Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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