Neurology
Dr.Shrikant Londhe- Patil

SUBARACHNOID HEMORRHAGE

What is subarachnoid hemorrhage?

A subarachnoid haemorrhage (SAH) is a form of stroke in which bleeding occurs into the fluid-filled space surrounding the brain (called the subarachnoid space). It is usually caused by the rupture of a swelling (called as an aneurysm) on one of the arteries ( Blood vessels) in the brain.

SAH is a medical emergency. It is also a catastrophe: half of people who have SAH will die, and around half of the survivors are left with significant disability.

What are symptoms of subarachnoid haemorrhage?

  1. Headache: The headache of subarachnoid haemorrhage is severe, often described as the most severe headache patients have ever experienced.(If you have an episode of sudden severe headache - coming on in minutes or less and being worse than headaches you have normally experienced - seek medical advice at once)
  2. Vomiting : Severe sudden headache with vomiting you should seek medical advice.(Generally this is as result of increased pressure inside your brain)
  3. Seizures: Abnormal movement of part of the body or entire body with unrolling of eyeballs, drooling of saliva, involuntary micturition should suggest seizure. A few people with SAH have a seizure due to irritation of the brain by the bleeding.
  4. Confusion or altered consciousness: If someone is unconscious they cannot tell you they have a headache. If someone complains of a severe headache then becomes unexpectedly drowsy, make sure that medical attendants are aware that the headache came first, as this suggests SAH.

How common is subarachnoid haemorrhage?

Approximately 6 out of 100 strokes are due to subarachnoid haemorrhage. Even though its rare, diagnosis and early treatment at experienced neurovascular centre is of paramount importance as SAH can be life-threatening if left untreated.

Are there warning symptoms for subarachnoid haemorrhage?

Few patient might have warning signs in the form of brief episode of severe headache, eye pain, visual problems or double vision and loss of sensations. These are often followed by more severe symptoms. Mild symptoms are secondary to minimal blood leakage inside the brain (Sentinel bleeding).

How does subarachnoid haemorrhage occurs?

This is most commonly secondary to rupture of swollen blood vessel inside the brain, known as aneurysm. Most commonly this phenomenon is triggered by increase blood pressure or some form of stress. Underlying risk factors are smoking, high blood pressure, drug abuse, family history and diseases which affects blood vessels of body. Once the bleeding happens, ruptured spot gets temporarily sealed by mechanical pressure from outside blood clot. If the ruptured aneurysm is not treated, high chance of repeat bleeding is there which has high mortality/morbidity.

What should done if I have an aneurysm which is not ruptured?

If you have incidental detected brain aneurysm, treatment is indicated depending on size of the aneurysm, location of the aneurysm and risk to the patient life, Generally if the aneurysm size is less than 7mm size, then follow up scan is advised to see for any growth of the aneurysm. Any aneurysm more than 7mm size/ growth is noted on serial scanning/ family history of aneurysm rupture/ underlying risk factors like smoking or high blood pressure, it is advised to treat that aneurysm.

What are the treatment options for the brain aneurysm?

First of all, treatment of aneurysm id divided into two categories Surgical clipping- in this treatment option, vascular neurosurgeon open the part of the skull bone and put clip around the aneurysm leading to its obliteration. Clipping prevent any blood entering into the aneurysm preventing its rupture.

Endovascular coiling- in this treatment option, interventional neuroradiologist treat the aneurysm without opening any part of skull bone. This is the most advanced treatment option in which blood vessels of the brain are approached through blood vessels of leg using small tubes known as catheters. Once we reach to the blood vessels of the brain, coils are placed inside the aneurysm which promotes its obliteration. Overall, this procedure has more safety factor compared to open surgical clipping.

Most Important thing is management of these diseases requires teamwork of vascular neurosurgery and interventional neuroradiology. Multiple studies have shown successful outcome when these procedures are done at dedicated neurovascular centre having expertise of both the speciality (Neurosurgery and Neuroradiology).

Which doctor should I consult for the treatment of brain aneurysm?

If you have brain aneurysm diagnosed on CT angiography/MR angiography, you should visit either Neurosurgeon or Interventional Neuroradiologist for further management. Based on your scan assessment, physician will decide whether you require treatment or not and what form of the treatment (surgical clipping/ endovascular coiling).