Subarachnoid Hemorrhage Symptoms and Treatments

What is a Subarachnoid Hemorrhage (SAH)?

A Subarachnoid Hemorrhage is a hemorrhage in the space between the brain and the tissue covering the brain. It may occur with large clots within the brain.

A SAH is considered a medical emergency and is a potentially life-threatening condition.

How serious is a Subarachnoid Hemorrhage?

A subarachnoid hemorrhage (SAH) is catastrophic. 30% of people who have a SAH will not reach the hospital, and survivors are left with some degree of permanent disability.

This is due to the 50% of damage caused to the brain by initial bleeding, and then by a shortage of oxygen/nutrition to the brain caused by spasms. Only about 1 out of 4 people survive a SAH well enough to return to their normal, professional life.

How common is Subarachnoid Hemorrhage?

• For every 1 lakh, approximately 6-10 people will have a SAH annually.
• SAH causes approximately 6 out of every 100 strokes.
• SAH tends to affect a younger population compared to other strokes.

Are there warning symptoms for Subarachnoid Hemorrhage?

About 1 in 10 people with a SAH have some warning signs in the days or hours before the SAH occurs. The most common are:

• Brief, sudden headaches are considered to be ‘the worst headaches’ ever experienced.
• Double vision or loss of vision.
• Neck pain.

Symptoms of Subarachnoid Hemorrhage

• Sudden, severe headache – the pain is often described as similar to being hit on the head suddenly, resulting in intense and severe pain.
• Nausea and vomiting (feeling and being sick).
• Stiff neck.
• Slurred speech.
• Visual problems.
• Loss of consciousness.
• Seizure/convulsions.
• Confusion.
• Weakness on one side of the body.

How do you know if you or another family member is having a SAH?

• Very often, the key phrase associated with a SAH is ‘the worst headache of my life’.
• Sudden confusion, trouble speaking, or understanding.
• Sudden trouble seeing from one or both eyes.
• Sudden trouble walking, loss of balance/coordination, or dizziness.
• Sudden, severe headaches with no known cause.

If you have one or more of these symptoms that last more than a few minutes, don’t delay

What is the long-term outlook for patients with subarachnoid hemorrhage?

• Improvement will continue for about 18 months after the SAH.
• Often people face some impairment, but others do well.

Better outcomes are expected in the event of:

• A smaller bleed.
• A younger age.
• A patient who is brought in conscious at the time of the SAH.
• A third of those who survive will be dependent on caregivers.
• In a survey of patients who survived a SAH and were interviewed several years later:
• 1 in 4 had stopped working. B1 in 4 worked shorter hours or had a position with less responsibility.
• 1 in 4 said that they had completely recovered.
• A personality change is common after SAH, most often with increased irritability or increased emotional swings.

Treatment of Subarachnoid Hemorrhage

Initial Subarachnoid Hemorrhage treatment is aimed at:

• Stabilizing the patient.
• Preventing further bleeding.
• Preventing further brain injury.

Medicines are used to:

• Reduce blood pressure and improve blood supply to damaged parts of the brain.
• Prevent seizures which can worsen brain damage.

Surgery may be required:

• Control of raised ICP may require the drainage of CSF ( the brain) or the removal of blood.
• Often, the cause of a SAH is the abnormal ballooning of the blood vessel, known as an ‘ANEURYSM’. Aneurysms tend to burst and cause a SAH.
• In literature, there is a 30% chance of bleeding in a second hemorrhage. If bleeding does occur, the mortality rate is 50%. So, it is important to block this ‘balloon’ by either coiling or clipping.
• Most people with a SAH stay in the hospital for at least two weeks. Each case is unique and depends on the size and location of the hemorrhage (bleed). Sometimes the stay lasts longer, so that our team may observe the patient in case of vasospasms or other possible complications.

Some Guidelines for Family and Friends

The pain, confusion, and anxiety caused by the SAH can increase with noise, elevated levels of activity, and unnecessary demands. The goal is to make the patient feel peaceful and secure till the aneurysm is taken care of.

Our staff may limit the number and behavior of visitors to ensure that we maintain a peaceful and therapeutic setting.

Eat well, get enough sleep, ask others for help, and allow for some time away from the hospital. Saving your own strength can definitely be an act of love.

Caregivers are key to ensuring that their loved one is taking part in all the necessary therapies, even when it's not easy. Please help us ensure that the patient is:

A) Performing deep breathing exercises.

B) Following restrictions in bed positioning.

C) Wearing the inflatable calf wraps.

D) Following fluid restrictions (if needed).

E) Following all instructions from the medical team.

Responsibilities outside the hospital continue to demand attention, and taking care of your house, caring for your children, and staying connected with work are not acts of disloyalty. In fact, spending some time to keep things in balance is necessary in preserving the life your loved one wants to rejoin.

Social workers also assist with general information and referrals to community agencies. Discharge planners arrange for continuing therapy and nursing needs after the patient leaves the hospital. They may also arrange placement in rehabilitation or extended care facilities if needed.

What happens after leaving the Neuro Intensive Care Unit?

The focus of care will shift from battling against possible damage to returning to the activities of daily life. Before leaving the hospital, your nurse will give you details about follow-up care and the lifestyle changes that may be required. One of the most important things you will need to know is how to recognize and act upon any signs of another SAH.

Rehabilitation after Subarachnoid Hemorrhage

Rehabilitation helps lessen the effects of any problem after a stroke, allowing one to live as independently as possible. Stroke rehabilitation works best when the patient, family, and rehabilitation stay work together as a team. The program will focus on helping the patient re-learn skills and learn new ways to perform tasks, as well as teaching the family ways to best support recovery.

Rehabilitation may include one or more of the following:

• Physical Therapy
• Occupational Therapy
• Speech and Hearing Therapy

What precautions should I be taking after discharge?

• Continuing to take medication as prescribed.
• Keep up the fluid intake (2 – 3 liters a day for the first 2 – 3 weeks).
• Give up smoking.
• Don’t drive.
• Avoid activities like swimming / cycling / traveling for the first three months.
• Make sure that blood pressure is controlled.

Am I progressing quickly enough?

There is no set timescale. Each person is different. One can expect to have good days and bad days during the recovery. Tiredness and fatigue are common after any serious illness, especially after surgery.

Am I doing too much?

You will know if you are doing too much if you become exhausted and need to rest.

Will I ever be the same again?

It can take many months after a SAH to feel that life is getting back to ‘normal’. This is a very difficult question to answer, as everyone's recovery is different. There is not a great deal you can do to speed up your recovery. The main advice is to take it easy and listen to what your body is telling you.

Our Team involves:

Health Professionals:

Neurosurgeon: A specialist doctor who performs brain and spine operations.

Neurologist: A doctor who does not perform operations but specializes in the diagnosis and treatment of people with neurological conditions.

Interventional Radiologist: A specialist doctor performs procedures like the coiling of brain aneurysms.

Radiologist: A specialist doctor who performs, reports, and reads scans such as angiograms, CT scans, MRI scans, and X-rays.

Intensivist: A physician who looks after your basic parameters like pulse, BP, and other cardiac and respiratory issues.

Nurse Specialist: A nurse who specializes in a particular condition, for example, subarachnoid hemorrhage.

Neuro physiotherapist: A chartered physiotherapist who specializes in treating people with neurological conditions. A neuro physiotherapist will assess, plan and treat people with physical problems.

Speech and Language Therapist: A specialist health professional who assesses, plans, and treats people with communication and swallowing problems.

Counselor: A person trained to provide guidance related to personal or psychological problems.

Reviewed By:

Dr. Rajan Shah (Director and Head - Neurosurgery)

Nanavati Max Institute of Neurosciences