Subarachnoid hemorrhage (SAH) is a type of bleeding that occurs in the subarachnoid space. The subarachnoid space is located between the membranes that cover the brain (called arachnoid) and the spinal cord. It is a space filled with cerebrospinal fluid, which acts as a cushion to protect the brain and spinal cord.
When a subarachnoid hemorrhage occurs, it is usually due to the rupture of a blood vessel in that space. The released blood accumulates in the subarachnoid space, exerting pressure on the brain tissue and causing a series of symptoms.
Subarachnoid hemorrhage is a serious and potentially life-threatening medical condition that requires immediate medical attention.
Symptoms
Subarachnoid hemorrhage (SAH) can present with a variety of symptoms, which may vary in intensity and manifestation in each individual. Some of the most common symptoms associated with SAH include:
Severe headache: Headache is one of the most characteristic symptoms of SAH. It is described as a sudden, intense, and stabbing pain, often referred to as "the worst headache of my life." The headache usually appears suddenly and without an apparent cause, and is typically felt in the back of the head.
Neck stiffness: Neck stiffness, also known as nuchal rigidity, is another common symptom of SAH. It is characterized by difficulty or discomfort when bending the neck forward due to stiffness in the neck muscles. Neck stiffness may be accompanied by pain when moving the neck.
Altered mental status: SAH can affect brain function and cause changes in mental status. Patients may experience confusion, disorientation, difficulty concentrating, or alterations in consciousness. These changes can range from mild to severe, depending on the extent and severity of the bleeding.
Nausea and vomiting: Many people with SAH experience nausea and vomiting, which can occur due to irritation of the brain lining or changes in intracranial pressure. These symptoms may be present from the onset of bleeding or develop afterward.
Seizures: Some patients with SAH may experience seizures. Seizures are episodes of abnormal brain activity that can manifest as involuntary body movements, loss of consciousness, muscle contractions, or changes in consciousness. Seizures can occur both at the time of the hemorrhage and subsequently.
These symptoms are not exclusive to SAH and can also be associated with other medical conditions.
The main causes of subarachnoid hemorrhage (SAH) include:
Rupture of a cerebral aneurysm: A cerebral aneurysm is a dilation or weakness in the wall of an artery in the brain. When an aneurysm ruptures, it releases blood into the subarachnoid space. The pressure from the released blood causes characteristic symptoms of SAH.
Arteriovenous malformations (AVMs): Arteriovenous malformations are congenital abnormalities in the structure of the brain's blood vessels. They consist of abnormal connections between arteries and veins, without the presence of usual capillaries. These malformations can weaken and rupture, leading to a subarachnoid hemorrhage.
Severe traumatic brain injury: Severe traumatic brain injuries can cause a subarachnoid hemorrhage due to the rupture of blood vessels in the brain. Direct impact to the head can result in injuries to the arteries and veins, causing bleeding in the subarachnoid space.
Coagulopathies and bleeding disorders: Conditions that affect blood coagulation capacity, such as hemophilia, platelet disorders, or the use of anticoagulants, can increase the risk of bleeding, including subarachnoid hemorrhage.
Use of stimulant drugs: The consumption of certain stimulant drugs, such as cocaine or amphetamines, can increase blood pressure and the fragility of blood vessels, thereby increasing the risk of rupture and subarachnoid hemorrhage.
Each of these causes can trigger a subarachnoid hemorrhage, but it is important to note that the rupture of a cerebral aneurysm is the most common cause.
Treatment
The treatment of subarachnoid hemorrhage (SAH) focuses on controlling the bleeding, preventing complications, and treating the underlying cause. The main treatment approaches include:
Medical and intensive care management:
After the diagnosis of SAH, medical and intensive care attention is provided to stabilize the patient. This involves close monitoring of vital signs, blood pressure control, administration of medications to prevent complications, and pain management.
Treatment of cerebral aneurysm:
If the cause of SAH is the rupture of a cerebral aneurysm, addressing the aneurysm is necessary to prevent future hemorrhages. This can be done through surgical techniques or endovascular procedures. Surgery may involve placing a metal clip on the neck of the aneurysm to stop blood flow or the "wrapping" technique to cover the aneurysm and prevent its rupture. The endovascular option utilizes catheters and coils (small spirals) to block the aneurysm and prevent bleeding.
Treatment of arteriovenous malformations (AVMs):
If SAH is caused by an AVM, endovascular embolization or surgery may be chosen to close or remove the malformation and prevent future bleeding.
Blood pressure control and prevention of complications:
It is important to keep blood pressure under control to prevent rupture or recurrent bleeding. Medications may be administered to lower blood pressure and reduce stress on blood vessels.
Rehabilitation and post-care:
After treatment, rehabilitation may be required to aid in physical and cognitive recovery. This may involve physical, occupational, and speech therapy, depending on the individual needs of the patient. Additionally, regular check-ups and follow-ups will be conducted to assess progression and prevent long-term complications.
The treatment of SAH is complex and varies depending on the severity of the bleeding, the location of the aneurysm or AVM, as well as the patient's characteristics and overall health. A multidisciplinary approach involving neurosurgeons, neurologists, interventional radiologists, and other intensive care specialists is crucial to provide the best possible treatment and optimize outcomes.
7 Tips for Prevention
Subarachnoid hemorrhage (SAH) often occurs unpredictably, but there are some general tips that can help reduce the risk of its occurrence. Prevention recommendations include:
1. Control your blood pressure: Maintaining a healthy blood pressure is crucial as high blood pressure is a significant risk factor for SAH. Adopt a healthy lifestyle that includes a balanced diet low in salt, regular exercise, and, if necessary, medications prescribed by a healthcare professional to keep blood pressure under control.
2. Avoid tobacco use: Smoking is associated with an increased risk of SAH and other cardiovascular diseases. If you smoke, consider quitting and seek professional help if needed. Also, avoid exposure to secondhand smoke.
3. Limit alcohol consumption: Excessive alcohol consumption can increase the risk of SAH and other cerebrovascular conditions. If you drink alcohol, do so in moderation following the guidelines recommended by health experts.
4. Maintain a healthy lifestyle: Adopt healthy habits such as having a balanced diet rich in fruits, vegetables, and low-fat foods, maintaining a healthy weight, exercising regularly, and managing stress. These measures help maintain a healthy cardiovascular system and reduce the risk of cerebrovascular diseases.
5. Treat underlying medical conditions: If you have chronic medical conditions such as diabetes, heart diseases, or coagulation disorders, it is essential to receive proper monitoring and treatment to control them and reduce the risk of complications, including SAH.
6. Identify and treat family risk factors: If you have a family history of cerebral aneurysms or vascular diseases, it is important to inform your doctor so they can assess your individual risk and, if necessary, conduct screening tests or provide preventive treatment recommendations.
7. Maintain good brain health: Some research suggests that leading a mentally active life and maintaining good brain health can contribute to the prevention of cerebrovascular diseases. Engage in activities that stimulate your mind, such as reading, word games, puzzles, and continuous learning.
These prevention tips are general, and it is important to consult a healthcare professional for personalized recommendations tailored to your situation.
Subarachnoid hemorrhage is a serious condition that requires immediate medical attention. Being aware of the symptoms and seeking urgent medical help if SAH is suspected can make a difference in the patient's prognosis and recovery. Additionally, adopting preventive measures can help reduce the risk of this potentially devastating condition.
References:
www.ncbi.nlm.nih.gov/books/NBK441958/
www.redaccionmedica.com/recursos-salud/diccionario-enfermedades/hemorragia-subaracnoidea