What Is a Subarachnoid Hemorrhage?
When there is bleeding in the space between the brain and the outer layers that cover it, the condition is called a subarachnoid hemorrhage. It happens when a blood vessel on top of the brain bursts, and blood starts pooling around the brain. In the confined spaces within the skull, this blood builds pressure upon the brain and compresses it. This may result in irreversible brain damage, functional impairment, paralysis, or long-term disabilities in an individual. This is why early detection and management are very critical for subarachnoid hemorrhage.
What Are the Causes of a Subarachnoid Hemorrhage?
The arachnoid membrane is one of the three layers that covers and protects the brain (meninges). The space between the arachnoid membrane and the brain is known as the subarachnoid space. The most common cause of spontaneous subarachnoid hemorrhage is the breakage of blood vessels. One may develop weak areas in the blood vessels, bulging up like a balloon (aneurysms) due to various reasons. This is prone to burst over time and cause a hemorrhagic stroke. Thereafter, the blood seeps over to the adjacent structures inside the brain and reaches the subarachnoid space.
The bulk of blood may compress or displace the nerve tissues causing irreversible damage. The contents of the blood irritate the other blood vessels inside the brain and make them shrink (vasospasm) as well. This may also induce an episode of stroke. Another important cause of bleeding is traumatic injuries of the head from falls, automobile accidents, sports injuries, or physical abuse. Individuals with the following conditions belong to the high-risk category:
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High blood pressure.
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Family background of aneurysms.
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Smoking and alcohol abuse.
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Conditions like Ehlers-Danlos syndrome, Marfan syndrome, and Polycystic kidney disease.
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Long-term use of blood thinners.
What Are the Risks Associated With Aneurysms?
Aneurysms of the brain can be cerebral, intracranial, or intracerebral aneurysms depending on their location in the brain. In most conditions, an aneurysm goes unnoticed till it ends up in a subarachnoid hemorrhage. The following conditions are pointers to a possible aneurysm inside the brain. One should consult a doctor if there are:
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Dilated pupils, pain around the eye, and eyesight problems.
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Hearing loss and issues with balancing.
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One-sided weakness of the body.
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Seizure attacks.
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Problem retaining memories.
What Are the Signs and Symptoms of a Subarachnoid Hemorrhage?
The most important symptom is the headache which people describe as the worst headache of their life. It is typically called a thunderclap headache which is different and much more severe than any other type of headache. Along with that, one may experience:
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Nausea or vomiting.
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Stiffness in the neck.
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Loss of consciousness.
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Seeing two of everything (double vision) and drooping eyelids.
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Discomfort with bright light.
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Slurred speech.
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Seizure attacks.
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Mental confusion and inability to concentrate.
What Are the Longstanding Complications of Subarachnoid Hemorrhage?
Longstanding subarachnoid hemorrhage may result in swelling and fluid collection inside the head, causing a pressure buildup (hydrocephalus). There are chances of repeated episodes of bleeding and stroke due to shrinkage of adjacent blood vessels. Even though some individuals make a full recovery from subarachnoid hemorrhage, many suffer:
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Recurrent seizure attacks.
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Frequent headaches.
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Weakness of body parts.
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Paralysis.
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Cognitive function impairment; involves thinking, planning, reasoning, memory, and ability to focus.
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Communication defects involving speech and language.
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Problems with vision.
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Altered mental status, mood swings, anxiety, and depression.
How Is a Subarachnoid Hemorrhage Diagnosed?
Subarachnoid hemorrhage is a medical emergency condition. The doctor does a review of the medical history and conducts a physical examination. This is followed by neurological and eye examinations. There are several tests one may undergo to diagnose subarachnoid hemorrhage, such as:
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Imaging studies like computed tomography (CT) scans and magnetic resonance imaging (MRI) will show the extent of hemorrhage and blood vessel ruptures.
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Cerebral angiography, where one injects a contrasting dye and identifies the source of bleeding by monitoring the path of blood flow in the X-ray.
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Lumbar puncture (spinal tapping), where the doctor inserts a needle into the lower back and accesses the spinal column. A sample of the cerebrospinal fluid (CSF) is extracted and checked for the presence of red blood cells. It is indicative of bleeding in the subarachnoid space.
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An electroencephalogram (EEG) is a procedure to study the pattern of electrical impulses produced by the brain, which helps identify areas of brain damage or malfunction due to bleeding.
What Is the Treatment for Subarachnoid Hemorrhage?
On admission to the hospital, the individual requires intensive care to stabilize the vital functions. The immediate plan of action is to stop the bleeding process. Following are the treatment modalities in practice:
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Urgent surgery to access the area of bleeding, where the surgeon puts a clip on the leaking blood vessel to prevent further bleeding.
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Endovascular coiling (embolization) is another treatment modality where a coil is inserted into the aneurysm to form a clot so that it does not burst. One inserts a wire through the blood vessels in the groin or arm and guides it upwards to the brain till it reaches the exact spot of the aneurysm.
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A bypass procedure may help, where the blood flows through the vessel with the aneurysm surgically guided through another vessel; so that the aneurysm disappears over time.
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A lumbar puncture or spinal tapping helps drain the excess cerebrospinal fluid that gets collected in the head (hydrocephalus) and relieves the pressure on the brain.
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One may prescribe medications to regulate blood pressure and manage seizures, vasospasm, and headaches.
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One is advised to avoid the possible risk factors causing aneurysms like smoking, uncontrolled diabetes, increased blood pressure, increased blood cholesterol, etc. One should strive to maintain a healthy lifestyle, eat right, and regulate one’s body weight as well.
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Individuals suffering from long-term neurological consequences of subarachnoid hemorrhage may require rehabilitation to improve their quality of life in the form of physical, occupational, speech, or language therapy.
Conclusion:
Subarachnoid hemorrhage is a life-threatening situation that usually affects people above the age of forty. A severe hemorrhage may end up in a coma stage or lifelong paralysis. Symptoms of this condition may look like other medical issues and tend to go ignored. The classic feature of subarachnoid hemorrhage is the agonizing headache it causes. Getting medical help at the earliest is vital for the best treatment outcomes.