Subarachnoid Hemorrhage

A subarachnoid hemorrhage is bleeding in the subarachnoid space, the area between the brain and the membrane that covers it. It is a type of stroke and is most often linked to a ruptured brain aneurysm, though trauma and blood vessel abnormalities can also cause it.

Because bleeding can raise pressure inside the skull and irritate nearby blood vessels, subarachnoid hemorrhage is a medical emergency.

Subarachnoid hemorrhage may be described by its cause:

• Aneurysmal subarachnoid hemorrhage, caused by a ruptured brain aneurysm
• Traumatic subarachnoid hemorrhage, caused by head injury
• Nonaneurysmal spontaneous subarachnoid hemorrhage, which may be linked to other blood vessel problems, including arteriovenous malformation

Symptoms often appear suddenly. The most common warning sign is a severe headache that feels like the worst headache of your life.

Other symptoms may include:

• Nausea
• Vomiting
• Neck stiffness
• Sensitivity to light
• Confusion
• Fainting
• Seizure
• Double vision
• Trouble speaking
• Weakness
• Numbness
• Loss of consciousness

Seek emergency care right away for these symptoms.

Subarachnoid hemorrhage can happen when a weakened blood vessel ruptures and leaks blood around the brain. A ruptured brain aneurysm is a common cause of spontaneous subarachnoid hemorrhage.

Risk factors may include:

• High blood pressure
• Smoking
• Heavy alcohol use
• Stimulant drug use
• Family history of aneurysm
• Certain connective tissue disorders
• Prior aneurysm
• Previous hemorrhagic stroke

Doctors diagnose subarachnoid hemorrhage quickly because treatment is time-sensitive. Testing may include:

• CT scan
• MRI
• CT angiography
• Cerebral angiogram
• Lumbar puncture

These tests help identify blood in the cerebrospinal fluid, locate a ruptured aneurysm and determine the cause of bleeding.

Baptist Health stroke specialists may also use advanced imaging to identify blood vessel narrowing or other causes of hemorrhage. Diagnostic results help determine whether treatment such as endovascular coiling may be appropriate.

Treatment focuses on stopping bleeding, preventing rebleeding, reducing pressure on the brain and preventing complications.

Treatment may include:

• Blood pressure management
• Medications to reduce blood vessel spasm
• Seizure management
• Intensive neurocritical care monitoring
• Rehabilitation services

When an aneurysm is the cause, treatment may include endovascular coiling, surgical clipping or other advanced endovascular procedures.

Subarachnoid hemorrhage can lead to serious complications, including:

• Rebleeding
• Hydrocephalus
• Seizures
• Brain swelling
• Blood vessel spasm (vasospasm)
• Additional stroke
• Cognitive impairment
• Weakness
• Long-term disability
• Coma

Rapid diagnosis and treatment can significantly reduce the risk of permanent brain injury.

Not every subarachnoid hemorrhage can be prevented, but managing risk factors may lower risk.

Prevention strategies include:

• Controlling high blood pressure
• Quitting smoking
• Limiting alcohol consumption
• Avoiding stimulant drugs
• Managing cholesterol and diabetes
• Following recommendations for known aneurysms

People with a family history of aneurysm should discuss screening and monitoring with their physician.

Call 911 immediately if you or someone nearby experiences:

• A sudden severe headache
• Loss of consciousness
• Seizure
• Confusion
• Weakness
• Vision changes
• Trouble speaking

After emergency treatment, your care team may recommend follow-up imaging, rehabilitation, medication management and appointments with stroke, neurosurgery or neurovascular specialists.

To schedule a visit with a Baptist Health Brain & Spine Care provider, fill out an appointment request form or call 833-596-3876.