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Subarachnoid hemorrhage

Hemorrhage - subarachnoid; Subarachnoid bleeding

Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space. Subarachnoid bleeding is an emergency and prompt medical attention is needed.

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Causes

Subarachnoid hemorrhage can be caused by:

Subarachnoid hemorrhage caused by injury is often seen in the older people who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes.

Risks include:

A strong family history of aneurysms may also increase your risk.

Symptoms

The main symptom is a severe headache that starts suddenly (often called thunderclap headache). It is often worse near the back of the head. Many people often describe it as the "worst headache ever" and unlike any other type of headache pain. The headache may start after a popping or snapping feeling in the head.

Other symptoms:

Other symptoms that may occur with this disease:

Exams and Tests

Signs include:

If your doctor thinks you have a subarachnoid hemorrhage, a head CT scan (without contrast dye) will be done right away. In some cases, the scan is normal, especially if there has only been a small bleed. If the CT scan is normal, a lumbar puncture (spinal tap) may be done.

Other tests that may be done include:

Treatment

The goals of treatment are to:

Surgery may be done to:

If the person is critically ill, surgery may have to wait until the person is more stable.

Surgery may involve:

If no aneurysm is found, the person should be closely watched by a health care team and may need more imaging tests.

Treatment for coma or decreased alertness includes:

A person who is conscious may need to be on strict bed rest. The person will be told to avoid activities that can increase pressure inside the head, including:

Treatment may also include:

Outlook (Prognosis)

How well a person with subarachnoid hemorrhage does depends on a number of different factors, including:

Older age and more severe symptoms can lead to a poorer outcome.

People can recover completely after treatment. But some people die, even with treatment.

Possible Complications

Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is much worse.

Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.

Other complications include:

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you or someone you know has symptoms of a subarachnoid hemorrhage.

Prevention

The following measures may help prevent subarachnoid hemorrhage:

Related Information

Aneurysm in the brain
Cerebral arteriovenous malformation
Aneurysm
Polycystic kidney disease
Stroke
Headache - what to ask your doctor

References

Mayer SA. Hemorrhagic cerebrovascular disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 408.

Szeder V, Tateshima S, Duckwiler GR. Intracranial aneurysms and subarachnoid hemorrhage. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 67.

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Review Date: 3/11/2019  

Reviewed By: Alireza Minagar, MD, MBA, Professor, Department of Neurology, LSU Health Sciences Center, Shreveport, LA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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