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Subarachnoid Hemorrhage - Causes, Symptoms, Complications, and Management

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Subarachnoid hemorrhage is a sudden occurrence of bleeding into the space between the brain and its outer membranes due to trauma or rupture of blood vessels

Written by

Dr. Jayasree S

Medically reviewed by

Dr. Seyedaidin Sajedi

Published At September 15, 2022
Reviewed AtDecember 9, 2022

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:

  1. High blood pressure.

  2. Family background of aneurysms.

  3. Smoking and alcohol abuse.

  4. Substance abuse.

  5. Conditions like Ehlers-Danlos syndrome, Marfan syndrome, and Polycystic kidney disease.

  6. Fibromuscular dysplasia.

  7. 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:

  1. Dilated pupils, pain around the eye, and eyesight problems.

  2. Hearing loss and issues with balancing.

  3. One-sided weakness of the body.

  4. Seizure attacks.

  5. 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:

  • Nausea or vomiting.

  • Stiffness in the neck.

  • Loss of consciousness.

  • Seeing two of everything (double vision) and drooping eyelids.

  • Discomfort with bright light.

  • Slurred speech.

  • Seizure attacks.

  • 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:

  • Recurrent seizure attacks.

  • Frequent headaches.

  • Weakness of body parts.

  • Paralysis.

  • Cognitive function impairment; involves thinking, planning, reasoning, memory, and ability to focus.

  • Communication defects involving speech and language.

  • Problems with vision.

  • 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:

  1. Imaging studies like computed tomography (CT) scans and magnetic resonance imaging (MRI) will show the extent of hemorrhage and blood vessel ruptures.

  2. 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.

  3. 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.

  4. 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:

  1. Urgent surgery to access the area of bleeding, where the surgeon puts a clip on the leaking blood vessel to prevent further bleeding.

  2. 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.

  3. 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.

  4. 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.

  5. One may prescribe medications to regulate blood pressure and manage seizures, vasospasm, and headaches.

  6. 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.

  7. 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.


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.

Frequently Asked Questions


What Are the Most Common Causes of Subarachnoid Hemorrhage?

Bleeding in the area between the brain and the surrounding membrane is known as a subarachnoid hemorrhage. The most frequent cause of a subarachnoid hemorrhage is a ruptured brain aneurysm, a burst of blood vessels in the brain. A blood vessel bulge in the brain known as a brain aneurysm is caused most commonly by a weakening in the blood vessel wall. Another frequent cause of subarachnoid hemorrhage is head trauma, which can result from a bad fall or a road traffic accident.


What Are the Primary Symptoms of Subarachnoid Hemorrhage?

The primary sign of subarachnoid hemorrhage is a sudden, severe headache. A sudden, terrible headache unlike anything the person has ever encountered, a stiff neck, photophobia, blurred or double vision, and stroke-like symptoms like slurred speech and weakness on one side of the body are among the symptoms. The rapid onset of a strong headache, frequently accompanied by nausea, vomiting, and loss of consciousness, are the primary warning signs of a subarachnoid hemorrhage.


How Can Subarachnoid Hemorrhage Be Treated?

Hospitalization is necessary to provide supportive care, control bleeding, and prevent brain damage. Surgery and catheter-based treatments are both options for treatment. Stopping the bleeding is the major objective of treatment for subarachnoid hemorrhages. To prevent blood from seeping into the brain, a doctor will frequently perform surgery to attach a small clip to the blood vessel, or an endovascular coil (which prevents blood flow into an aneurysm) can be used to treat some types of aneurysms.


How Can Subarachnoid Hemorrhage Be Diagnosed?

The most accurate imaging test for subarachnoid hemorrhage is Computed tomography (CT) without contrast. CT offers 100% sensitivity and specificity when performed within 6 hours of headache onset. However, magnetic resonance imaging (MRI) is still regarded as the gold standard for diagnosing subarachnoid hemorrhages. A lumbar puncture, also known as spinal tapping, may also be performed, which involves the physician inserting a needle into the lower back to access the spinal column, extracting a sample of the cerebrospinal fluid, and analyzing it for red blood cells.


What Are the Most Common Risk Factors for Subarachnoid Hemorrhage?

The three most common risk factors for subarachnoid hemorrhage are smoking, high blood pressure, and excessive drinking. Other risk factors include having an unruptured aneurysm in the body, whether it is in the brain or elsewhere, using blood thinners like warfarin, having a strong family history of aneurysms, having a history of polycystic kidney disease, having fibromuscular dysplasia, Ehlers-Danlos syndrome, or another connective tissue disease, or taking cocaine or methamphetamine.


What Complications Might Subarachnoid Hemorrhage Cause?

Seizures, vasospasm (when a blood vessel in the brain constricts, obstructing blood flow), rebleeding or hemorrhaging after initial treatment, hydrocephalus (buildup of fluid in the brain), increased intracranial pressure, cerebral infarction (ischemic stroke), herniation, and death are all possible immediate complications. Long-term complications include fatigue, drowsiness, numbness in certain body areas, trouble swallowing, loss of balance, cognitive impairment, and slurred or delayed speech.


What Are the Three Phases of a Subarachnoid Hemorrhage?

Oligemia, hyperemia, and vasospasm were three distinct hemodynamic stages that were found to occur after subarachnoid hemorrhage. Brain metabolic alterations are related to each phase. When the brain's capacity to control cerebral blood flow by vasodilation is surpassed, oligemia results, and cerebral blood flow starts to decline. Hyperemia results from brain tissue acidosis resulting in microvascular bed dilatation and cerebral hyperemic conditions. It helps damaged tissue regain its balance. The final stage is Vasospasm when a brain blood vessel constricts and prevents blood flow. It can happen two weeks after a brain aneurysm or subarachnoid hemorrhage.


Subarachnoid Hemorrhage: Is It Normal?

The bleeding in the area around the brain, referred to as a subarachnoid hemorrhage, is a medical emergency and is life-threatening. Most often, adults over 40 experience it. Usually, the worst headache of one's life will manifest. Between 10 and 14 out of every 100,000 people in the United States get a yearly subarachnoid hemorrhage. It's a disorder that can be fatal and is very serious.


When Do the Signs of Brain Hemorrhage Begin?

It may take days or weeks for signs and symptoms of brain hemorrhage to appear following an accident. Chronic hematomas can arise from less severe head traumas and produce delayed bleeding; symptoms may not appear for weeks or months. Moreover, people might not recall experiencing head pain. The severity and prognosis are influenced by its etiology, position within the skull, size, time between the bleeding and treatment, age, and general health.


Can Stress Lead To Brain Bleeding?

Stress has a significant impact on brain activity. Stressed-out people can have high blood pressure, which damages the blood vessels and causes brain hemorrhage. Intracranial arteries may burst, leading to brain bleeding, as a result of a sudden rise in blood pressure caused by intense mental stress.


Can Stress Lead To Subarachnoid Hemorrhage?

Any bleeding under the arachnoid layer, one of the brain's protective layers, is called a subarachnoid hemorrhage. High blood pressure, strenuous activity, and emotional stress are some of the factors that may make an aneurysm or arteriovenous malformation rupture more likely.


What Is the Potential Mortality Risk From Subarachnoid Hemorrhage?

Subarachnoid hemorrhage, the worst stroke subtype, continues to have a high fatality rate of 40% to 60% despite breakthroughs in diagnostic and treatment methods over the past few decades. The initial hemorrhage is what causes the majority of subarachnoid hemorrhage-related deaths, which happen extremely quickly. The most significant preventable cause of death for hospitalized patients is rebleeding.


Can Subarachnoid Hemorrhage Results in Death?

The subarachnoid hemorrhage outlook is based on the cause, the extent, and the occurrence of further problems or injuries. Half of those who encounter subarachnoid hemorrhage die suddenly, making it a serious condition. 25% of patients pass away within 24 hours, whether or not they receive medical care. The average first-month death rate for patients in hospitals is 40%. About half of the people affected pass away in the first six months after being affected.


In a Subarachnoid Hemorrhage, What Is the Target Blood Pressure?

A risk factor for rebleeding in unsecured aneurysms is elevated blood pressure. According to American Stroke Association/ American Heart Association recommendations, blood pressure should be kept below 160 mm Hg before the aneurysm is clipped.


What Is the Subarachnoid Hemorrhage First Aid Procedure?

It is important to identify a suspected subarachnoid hemorrhage by its warning signs, such as sudden, severe headaches, and to seek emergency medical attention. Neurosurgery may be necessary as soon as possible for the patients to stop the internal bleeding. There are no first aid measures one can take as a first responder to stop the bleeding other than getting medical attention immediately.
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Dr. Seyedaidin Sajedi
Dr. Seyedaidin Sajedi



subarachnoid haemorrhage
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