Subarachnoid hemorrhage: symptoms, causes and treatment

Definition of subarachnoid hemorrhage

What is subarachnoid hemorrhage?

Subarachnoid hemorrhage (subarachnoid hemorrhage/ SAH) is bleeding that occurs in the subarachnoid space, which is the space between the two layers of membranes covering the brain or the meninges membrane.

The meninges membrane is the protective membrane of the brain which consists of three layers, namely the pia meter (inside), the arachnoid (middle), and the dura meter (outside). The subarachnoid space is just below the arachnoid layer and above the pia meter.

The subarachnoid space contains brain fluid called cerebrospinal fluid, as well as the main blood vessels that carry nutrients and oxygen to the brain. When the blood vessels on the outer surface of the brain burst, the subarachnoid space quickly fills with blood and mixes with the cerebrospinal fluid. This can increase pressure on the brain and can lead to coma, paralysis, physical disability, and even death.

Subarachnoid hemorrhage is a type of stroke that occurs as a result of cerebral hemorrhage, namely hemorrhagic stroke. Another type of hemorrhagic stroke is called intracerebral hemorrhage, which causes bleeding within the brain.

How common is subarachnoid hemorrhage?

Generally, subarachnoid hemorrhage occurs as a result of head injury or trauma. However, this condition can also occur due to the rupture of an abnormal lump in a blood vessel (aneurysm) in the brain.

Subarachnoid hemorrhage is a medical emergency. Therefore, someone who experiences this condition needs to get medical care immediately to avoid complications, especially the risk of death.

Reporting from The Internet Stroke Center, subarachnoid hemorrhage can happen to anyone at any age, including adolescents and young adults. Meanwhile, women experience this condition more often than men.

However, brain aneurysms generally occur after the age of 40, although this condition can also occur from birth or childhood and develop very slowly. Therefore, due to brain aneurysms are more at risk of occurring at that age.

Signs & symptoms of subarachnoid hemorrhage

What are the symptoms of subarachnoid hemorrhage that can arise?

The main sign and symptom of subarachnoid hemorrhage is a sudden, severe headache (thunderclap headache). This symptom is often felt badly in the back of the head (back headache). In fact, many people describe it as "the worst headache" and it is different from other types of headaches.

Other symptoms include:

• Decreased awareness and alertness.
• Eye discomfort to blinding light (photophobia).
• Mood and personality changes, including confusion and irritability.
• Muscle pain (especially neck, shoulder, or back pain).
• Nausea and vomiting.
• Weakness or numbness in parts of the body.
• Seizures.
• Dizzy.
• Stiff neck.
• Difficulty speaking.
• Vision problems, including double vision, visible spots, or temporary loss of vision in one eye.

Before subarachnoid hemorrhage occurs, you may experience other symptoms associated with a brain aneurysm, such as pain around the eye, change in the size of the pupil in the eye, hearing loss or balance problems, or difficulty with memory. However, some people with brain aneurysms may not experience any symptoms.

Some of the other symptoms or signs may not be listed above. If you feel anxious about these symptoms, consult your doctor immediately.

When to see a doctor?

The above symptoms may look like other medical conditions or problems. To be sure, you should immediately consult a doctor if you experience any of the signs or symptoms above. Moreover, subarachnoid hemorrhage is an emergency medical condition that requires immediate treatment.

Please also note, every body acts differently from one another. Talk to your doctor about the best solution for your situation.

Causes of subarachnoid hemorrhage

What are the common causes of subarachnoid hemorrhage?

A common cause of subarachnoid hemorrhage is injury or trauma to the head. In the elderly, this condition usually occurs due to a fall that causes a head hit. Meanwhile, in young adults or adolescents, head injuries usually occur due to motor vehicle accidents.

Apart from traumatic conditions, the most common cause of subarachnoid hemorrhage is a ruptured brain aneurysm. Aneurysm itself is a swelling or lump in a blood vessel in the brain. In the area of ​​the swelling, the walls of the blood vessels can weaken, making the lump prone to rupture.

The cause of the aneurysm itself is unknown. However, several factors can increase a person's risk of developing an aneurysm in the brain.

Less common causes

Apart from these common causes, here are some conditions that can also cause them subarachnoid hemorrhage:

• Bleeding from a collection of blood vessels called arteriovenous malformation (AVM).
• Bleeding disorders.
• Use of blood thinners or cocaine.

In some cases, the cause of subarachnoid hemorrhage can be unknown (idiopathic).

What increases the risk of developing subarachnoid hemorrhage?

Apart from the above causes, certain factors may increase a person's risk of developing subarachnoid hemorrhage. Here are some of the factors:

• Have had a brain aneurysm or have had a brain aneurysm that doesn't rupture.
• Fibromuscular dysplasia (FMD) and other connective tissue disorders.
• High blood pressure.
• History of polycystic kidney disease.
• Smoke.
• Excessive alcohol consumption.
• Use of illegal drugs, such as cocaine or methamphetamine.
• Use of blood thinners, such as warfarin.
• Family history of brain aneurysms.

Not having risk factors does not mean you cannot get this disease. These factors are for reference only. Consult a doctor for more details.

Diagnosis and treatment of subarachnoid hemorrhage

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How do doctors diagnose subarachnoid hemorrhage?

Doctors make an initial diagnosis based on the symptoms that appear. To check for these symptoms, the doctor will generally perform a physical examination to look for possible stiff neck, brain and nervous system tests to look for signs of decreased nerve and brain function, and eye examinations that may show decreased eye movement.

If your doctor thinks you have subarachnoid hemorrhage, a CT scan of the head (without contrast dye) will be done immediately. However, in some cases, a CT scan may show normal results, especially if the bleeding is only light.

In this condition, spinal fluid collection (lumbar puncture test / spinal tap) may be an option. Apart from that, other tests can also be done. Some of these tests, namely:

• Angiography of the brain in cerebral blood vessels.
• Angiography CT scan (with contrast dye).
• Doppler transcranial ultrasound, to observe blood flow in the arteries of the brain.
• Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA).

What are the treatment options for subarachnoid hemorrhage?

Subarachnoid hemorrhage is an emergency. Therefore, immediate medical attention is needed to stop bleeding and reduce the risk of permanent brain damage.

In order to achieve this goal, surgical or surgical procedures are generally chosen by doctors. Surgery may be performed to remove blood clots or reduce pressure on the brain, especially if SAH is due to a head injury.

Meanwhile, if SAH occurs due to aneurysm, surgery is performed to repair the part that is experiencing an aneurysm. As for SAH due to aneurysms, there are two methods of surgery that are commonly performed, namely:

• Clipping procedure

The clipping procedure is performed by performing a craniotomy, which is to make an incision in the head and temporarily remove a small part of the skull. After that, a metal clip is placed around the base or neck of the aneurysm to stop the flow of blood.

• Endovascular coiling

In this procedure, a metal coil will be placed inside the aneurysm and a bag will be placed to wrap or support the metal coil. This metal coil is threaded using a catheter or thin tube through an artery in the leg (groin) to an artery in the brain.

This is done to reduce further bleeding in the area of ​​the aneurysm. This treatment is used more often because the recovery time tends to be shorter. However, not all aneurysms can be treated with this method.

Administration of drugs and special care

Apart from surgery, your doctor may also give you several drugs to help treat subarachnoid bleeding, such as:

• Medicines through an IV to control blood pressure.
• Medicines to prevent arterial spasms.
• Pain relievers and anti-anxiety medications to relieve headaches and reduce pressure on the skull.
• Medicines to prevent or treat seizures.
• Stool softeners or laxatives to prevent straining during bowel movements.

In addition, complete rest is very important and activities that can increase pressure in the head, such as bending over or changing body positions, should be avoided.

Meanwhile, people with subarachnoid hemorrhage who are comatose or lose consciousness will be given some special care. This treatment generally includes placing a drain tube in the brain, certain methods to protect the airway, and other techniques to support the sufferer's life. Always consult a doctor for the right type of treatment.

Home treatment of subarachnoid hemorrhage

Treatment for subarachnoid hemorrhage needs to be done long-term to reduce the risk of subsequent bleeding. Therefore, after undergoing medical treatment at the hospital, you need to make changes to your lifestyle and home remedies that might help treat this condition.

Here are some of these ways:

• Quit smoking.
• Maintain a healthy body weight.
• Eat a balanced nutritious diet.
• Control blood pressure.
• Control blood sugar, especially if you have a history of diabetes.
• Maintain normal cholesterol.

In addition, don't forget to continue periodic checkups to the doctor. Follow all of your doctor's instructions, including whether you need therapy that supports your daily activities, such as physical or speech therapy.

If you have any questions, consult your doctor for the best solution to your problem.

Subarachnoid hemorrhage complications

The most common complication is repeated bleeding. An aneurysm that has ruptured and is healing on its own may be able to burst again.

The recurrent bleeding will generally be worse than in the first case. Meanwhile, SAH that causes loss of consciousness can lead to coma or even death.

Further complications that may occur

In addition, other complications that may occur due to subarachnoid hemorrhage are:

• Swelling of the brain and hydrocephalus due to a buildup of cerebrospinal fluid and blood between the brain and skull.
• Brain damage due to reduced blood supply to the brain, which can lead to stroke.
• Paralysis or coma resulting from permanent brain damage.
• Seizures.
• Problems with cognitive function, such as impaired memory and concentration.
• Mood changes, such as depression.

Subarachnoid hemorrhage prevention

There are several things you can do to reduce the risk of subarachnoid bleeding, namely:

• Quit smoking and reduce alcohol consumption.
• Control and prevent high blood pressure by exercising regularly, eating a healthy diet, and losing weight if you are overweight. Check this BMI calculator to find out your ideal weight.
• Identify and treat potential brain problems or disorders, especially aneurysms.
• Use personal protective equipment, such as a helmet or face mask, during risky physical activity, such as at work or while playing sports.