Subarachnoid Hemorrhage
En Español (Spanish Version)

Definition
Subarachnoid hemorrhage is a type of stroke that occurs when a blood vessel ruptures. Blood quickly fills the area immediately surrounding the brain and spinal cord. This space contains the cerebrospinal fluid. The fluid cushions and bathes the brain and spinal cord.

This life-threatening condition requires emergency medical care. The hemorrhage may increase the pressure around the brain. It can interfere with the brain's ability to function.

Subarachnoid Hemorrhage

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Causes
Subarachnoid hemorrhage may be caused by:

  • Head trauma
  • Rupture of cerebral aneurysms and other blood vessel deformities
  • Bleeding disorders
  • Drug use , especially with cocaine and amphetamines
  • Brain tumors
Risk Factors
Factors that may increase your chance of developing subarachnoid hemorrhage include:

  • Past history of aneurysms
  • Hypertension , which increases the risk of aneurysm rupture
  • Smoking
  • Heavy alcohol consumption
  • Cocaine use
  • Disorders associated with weakened blood vessels, including polycystic kidney disease , fibromuscular dysplasia, or connective tissue disorders
  • Estrogen deficiency
  • Family history of aneurysms
Symptoms
Symptoms may include:

  • A very sudden, severe headache
  • Brief loss of consciousness
  • Seizures
  • Nausea and vomiting
  • Weakness on one side of your body
  • Unexplained numbness or tingling
  • Slurred speech or other speech disturbance
  • Visions problems, such as double vision, blind spots, or temporary vision loss on one side
  • Stiff neck or shoulder pain
  • Confusion
If you have these symptoms, call for emergency medical services right away. Early care can decrease the amount of damage to brain.

Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your cerebrospinal fluid may need to be tested. This can be done with a lumbar puncture .

Imaging tests evaluate the brain and surrounding structures. This can be done with:

Treatment
Subarachnoid hemorrhage is a serious condition. It typically requires initial treatment in the intensive care unit. Despite treatment, many people with this condition die.

The aim of treatment is to stop the bleeding, limit damage to the brain, and reduce the risk of it occurring again. If bleeding results from a cerebral aneurysm, a doctor will usually attempt to stop it using various techniques. Patients receive medication to ensure proper blood flow to the rest of the brain. Absolute bed rest is needed to prevent additional bleeding. After the situation is stabilized, patients undertake a vigorous rehabilitation program.

Prevention
Aneurysms present since birth cannot be prevented. Because they are so rare, doctors do not advise screening for them. If an unruptured aneurysm is discovered by chance in a young person, the doctor may do surgery.

Avoiding smoking and controlling blood pressure can reduce the risk of a rupture if an aneurysm exists. Wearing a seatbelt and using a helmet can also reduce the risk of subarachnoid hemorrhage from head trauma.




RESOURCES:
The Brain Aneurysm Foundation

National Stroke Association

CANADIAN RESOURCES:
Brain Injury Association of Canada

Heart and Stroke Foundation of Canada

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. 2007b;38(6):2001-23.

Feigin V, Parag V, Lawes CM, 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;36:1360.

Feigin VL, Rinkel GJ, Lawes CM, et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005 Dec;36(12):2773-80.

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

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

Mayberg MR, Batjer HH, Dacey R, 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;40:994.

Stroke rehabilitation. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 9, 2014. Accessed June 2, 2014.

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

Subarachnoid hemorrhage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 22, 2013. Accessed June 2, 2014.

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

Last Reviewed May 2014



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