A subarachnoid hemorrhage is an acute intracranial (into the interior of the skull) hemorrhage, most commonly due to a ruptured aneurysm, and has a poor prognosis. About 15 out of 100,000 people are affected by a subarachnoid hemorrhage each year.
What is a subarachnoid hemorrhage?
A subarachnoid hemorrhage is an acute intracranial hemorrhage into the subarachnoid space, which is located between the arachnoid (cobweb membrane) and the pia mater (vascular part of the meninges), which together form the soft meninges (leptomeninge). For corneal inflammation in English, please visit gradphysics.com.
Symptoms characteristic of a subarachnoid hemorrhage are sudden, very severe headaches in the back of the head (“annihilation headache”), nausea and vomiting, meningism (neck stiffness, sensitivity to light) and initial clouding of consciousness.
In the later course, unconsciousness, coma and circulatory and respiratory arrest are also characteristic of subarachnoid hemorrhage due to the increasing intracranial pressure.
Most subarachnoid hemorrhages result from a ruptured cerebral artery aneurysm. A cerebral aneurysm is usually caused by a genetically determined vascular wall weakness in the area of the base of the brain, as a result of which bulges develop in the vessels (aneurysms), which burst (rupture) and can lead to a subarachnoid hemorrhage.
Aneurysm rupture is favored by physical exertion such as lifting heavy objects or having sex.
In rarer cases, craniocerebral trauma, sinus vein thrombosis (occlusion of the large blood vessels in the brain), angiomas (vascular malformations), coagulation disorders and vascular inflammation can cause subarachnoid hemorrhage.
Hypertension (high blood pressure), nicotine use in hypercholesterolemia (elevated blood cholesterol levels), and drug use (heroin, amphetamines ) are factors that promote the manifestation of an aneurysm and thus subarachnoid hemorrhage.
Symptoms, Ailments & Signs
The first symptom of a subarachnoid hemorrhage is usually a sudden and extremely severe headache, known as an annihilation headache. Patients describe it as unbearable and never before experienced in a similar way. The pain usually starts in the forehead or the neck and spreads all over the head, sometimes to the back. However, this symptom can also be absent.
Those affected also suffer from a stiff neck, nausea, vomiting and increased sensitivity to light. Blood pressure may rise or fall, breathing rate changes, and body temperature often fluctuates. The pulse can beat irregularly and paralysis can occur.
Epileptic seizures are rare. The symptoms are divided into five grades, according to which the severity of the bleeding can be assessed. In grade I, only slight headaches occur. Grade II shows more severe headaches and the neck is stiff. If grade III is reached, drowsiness and milder neurological disorders such as paralysis or limited sensitivity are added.
Grade IV subarachnoid hemorrhage presents as a coma-like sleep. In addition, breathing disorders and hemiplegia occur. At grade V, there is severe bleeding and the patient falls into a coma. The pupils no longer react to light stimuli and pronounced neurological disorders occur.
Diagnosis & History
A subarachnoid hemorrhage is diagnosed on the basis of the characteristic symptoms, with the specific symptoms present providing information about the stage of the disease. Slight headaches and neck stiffness are associated with an early stage (grade I).
These increase in the further course and can be accompanied by cranial nerve failures (grade II). Additional clouding of consciousness and neurological focal symptoms indicate grade III of the disease. Symptoms such as somnolence or sopor (deep sleep), hemiparesis (half-sided paralysis), circulatory and respiratory disorders (grade IV) as well as coma, stretch cramps and disturbed vital functions (grade V) can then manifest themselves.
The diagnosis is backed up by imaging procedures such as computer tomography (first week after a subarachnoid hemorrhage), magnetic resonance imaging or lumbar puncture (from the 8th day). Doppler sonography is used to rule out possible vasospasms (vascular spasms), while angiography allows statements to be made about the exact localization of the aneurysm.
The prognosis for subarachnoid hemorrhage is poor. About half of those affected die within the first 30 days after a subarachnoid hemorrhage. In addition, despite a successful operation, there is an increased risk of impairment of brain functions.
In the worst case, the subarachnoid hemorrhage can lead to the death of the affected person. However, this only occurs if the condition is not treated. Those affected primarily suffer from very severe headaches. These can also spread to the neighboring regions of the body and lead to pain there as well.
Those affected also experience vomiting and nausea. These complaints also have a very negative effect on the patient’s quality of life. A high sensitivity to light and noise can also occur with subarachnoid hemorrhage and make everyday life difficult for the person affected.
Many patients also suffer from a very stiff neck and possibly also pain in this region. As the subarachnoid hemorrhage progresses, unconsciousness may occur, in which case the affected person may be injured if they fall. Bleeding is usually treated with surgery.
There are no particular complications and the symptoms can be alleviated. However, the risk of a stroke increases significantly due to the bleeding, so that the affected person continues to rely on various therapies and examinations. This may also reduce the patient’s life expectancy.
When should you go to the doctor?
This disease should always be treated by a doctor. The earlier the subarachnoid hemorrhage is recognized and treated, the better the further course of the disease in most cases. Only early diagnosis and subsequent treatment can prevent further complications or symptoms. If the subarachnoid hemorrhage is left untreated, it can lead to death in the worst case. A doctor should be consulted if the person concerned suffers from very severe headaches. In most cases, the person concerned can no longer concentrate and can no longer go about his or her everyday life.
A stiff neck and severe nausea associated with vomiting can also indicate a subarachnoid hemorrhage. Some sufferers are very sensitive to light or are even prone to an epileptic seizure. If such an attack occurs, go to a hospital or call an ambulance immediately. As a rule, the subarachnoid hemorrhage can be recognized by a general practitioner. For further treatment, however, a specialist and usually also a surgical intervention is necessary. No general prediction can be made about the further course and life expectancy of the patient.
Treatment & Therapy
In the case of a subarachnoid hemorrhage, the therapeutic measures are aimed at stabilizing the general condition of the affected person through intensive medical care. If an aneurysm has ruptured, surgical intervention is performed to isolate the vascular bulge from the blood circulation and stop the subarachnoid hemorrhage.
Two surgical procedures are used for this. In the so-called clipping procedure, the aneurysm is isolated from the bloodstream with the help of special clips at the vessel outlet in order to prevent further intracranial bleeding. In addition to this procedure, which takes place directly on the brain, a micro-spiral made of platinum (platinum coil) is inserted into the aneurysm in the coiling procedure, which is now more frequently used, using a catheter that is guided through the groin artery.
After the platinum coil has been placed, the spiral unwinds and as a result of the subsequent thrombosis, the meshes of the coil and thus the aneurysm are closed. Due to the increased risk of vascular occlusion, postoperative thrombosis prophylaxis should be used. If vasospasms (vascular spasms) are already present or if the affected person is in poor condition and surgical intervention is not possible, the increased risk of a stroke means that treatment is usually conservative until the spasms have subsided (at least 10-12 days) and an attempt is made to maintain blood circulation as far as possible.
Calcium antagonists such as nimodipine and infusions to thin the blood with a simultaneous increase in blood volume (hypervolemic haemodilution) are preferably used for this purpose. Intubation and ventilation may be necessary. If the subarachnoid hemorrhage is based on an angioma, this is often embolized to prevent recurrent hemorrhage. In addition, absolute bed rest is indicated after both conservative and surgical therapy to minimize the risk of postoperative bleeding.
Subarachnoid hemorrhage can only be prevented to a limited extent. Measures against high blood pressure, avoiding nicotine and excessive alcohol consumption and avoiding obesity through a healthy diet and regular exercise prevent aneurysms and thus indirectly subarachnoid hemorrhage.
Patients affected by subarachnoid hemorrhage usually have only a few and only limited follow-up measures available. For this reason, the patient should consult a doctor as soon as the first symptoms and signs of the disease appear, so that further complications can be prevented. As a rule, no self-healing can occur, so that the affected person is dependent on a medical examination and treatment.
The sooner a doctor is consulted, the better the further course of the disease. Most of those affected are dependent on an operative intervention, whereby the measures of radiotherapy or chemotherapy are usually also necessary. Regular check-ups by a doctor are also very important after the removal in order to identify and treat further tumors at an early stage.
Sufferers should generally rest and rest with this disease, although strict bed rest should also be observed in severe cases. As a rule, this disease does not reduce the patient’s life expectancy, and a general course cannot be predicted.
You can do that yourself
The everyday life of those affected is characterized in most cases by heteronomy. Because the damage is almost always accompanied by permanent disorders. Everyday life should be adapted to the severity and complexity of the impairments, with self-help always being the priority.
Relatives and carers can support those affected in everyday life by working according to the Bobath concept. The regulation of muscle tone, the initiation of normal movement processes and the promotion of body awareness are the three basic aspects. This results in an everyday life in which food intake, mobility, excretion, clothing and washing are supported. However, it is always necessary beforehand to release spastic paralysis through movement and to avoid negative stimuli, such as cold hands. Physiological movement sequences can be supported, especially with everyday activities such as brushing teeth, combing your hair or eating, whereby the bilateral arm movement must always be focused on.
People who have had a subarachnoid hemorrhage often suffer from reduced alertness. Therefore, the living situation must be rearranged accordingly and distractions eliminated. Because the brain can only adapt over time with a few stimuli.
The risk of falling is greatly increased by anosognosia, neglect or pusher syndrome. The avoidance of falls during positioning or mobilization must therefore always be considered, as these result in further immobility and dependence.