Subarachnoid hemorrhage

Subarachnoid hemorrhage is a collection of blood within the protective covering of the brain. This condition is generally characterized by severe headaches that occur suddenly.

Subarachnoid hemorrhage or subarachnoid hemorrhage (SAH) can occur spontaneously without a previous head injury. This condition is most often caused by a brain aneurysm , which is a bulge in an artery caused by a thinning blood vessel wall.

Patients with subarachnoid hemorrhage must immediately get medical treatment. If not, this condition risks causing permanent brain damage, even being life threatening.

Causes of Subarachnoid Hemorrhage

The lining of the brain (meninges) is the protective layer of the brain consisting of the dura mater layer, arachnoid layer, and pia mater layer. The subarachnoid space itself is located between the arachnoid layer and the pia mater.

The subarachnoid space is filled with fluid that protects the brain. In the subarachnoid space there are many blood vessels whose role is to carry nutrients and oxygen to the brain.

Subarachnoid hemorrhage can be divided into two, namely traumatic and non-traumatic. The following is an explanation:

Traumatic subarachnoid hemorrhage

Traumatic subarachnoid hemorrhage occurs as a result of a serious head injury , for example in a traffic accident. Severe head injuries can cause blood vessels in the lining of the brain to burst and result in subarachnoid hemorrhage.

Nontraumatic subarachnoid hemorrhage

Nontraumatic subarachnoid hemorrhage occurs spontaneously, eg rupture of a blood vessel due to a brain aneurysm. An aneurysm in a blood vessel in the brain causes the walls of the blood vessel to thin and form a very fragile bulge.

Nontraumatic subarachnoid hemorrhage can also occur due to bleeding from arteriovenous malformations , consumption of blood thinners, blood clotting disorders, infections, and complications due to bleeding in the brain that leaks into the subarachnoid space.

Risk factors for subarachnoid hemorrhage

Subarachnoid hemorrhage can occur in all age groups. In fact, some people are born with brain aneurysms that can cause this condition. In addition, there are several other factors that increase the risk of an aneurysm, namely:

Smoking habit
High blood pressure
Alcohol addiction
Family history of aneurysms
Polycystic kidney disease
Liver disease
Brain tumors, both malignant and benign, affecting the blood vessels
Encephalitis
Fibromuscular dysplasia or abnormal growths on the walls of blood vessels
Moyamoya disease, which is a rare condition that causes blockage of the blood vessels in the brain
vasculitis

Symptoms of Subarachnoid Hemorrhage

The main symptom that arises from subarachnoid hemorrhage is a severe headache that appears suddenly and has never been felt before. Other symptoms include:

Sudden dizziness, confusion, and weakness
Neck feels stiff
Shoulder and back ache
Nausea and vomiting
Blurred, double, or sensitive to light vision
Experiencing stroke symptoms, such as slurred speech and paralysis on one side of the limb
Loss of consciousness
seizures
Sleep disorders
Depression

When to see a doctor

Symptoms of subarachnoid hemorrhage can appear suddenly and cause the sufferer to experience a rapid loss of consciousness. This condition is classified as an emergency and requires immediate medical attention.

If you see someone showing signs of subarachnoid hemorrhage as above, seek medical help immediately.

Diagnosis of Subarachnoid Hemorrhage

The doctor will ask about the patient's symptoms, especially complaints of severe headaches, visual disturbances, and a stiff neck as the main symptoms of subarachnoid hemorrhage.

Furthermore, the doctor can carry out laboratory tests to support the diagnosis, such as a complete blood count, blood chemistry, and PT and APTT .

In someone who is suspected of having subarachnoid hemorrhage, the doctor can carry out other supporting examinations, such as:

Computerized Tomography (CT) scans

CT scans can provide an overview of the condition of blood vessels, including those in the brain. A type of CT scan that can see blood vessels more clearly is a CT scan angiography.

Magnetic Resonance Imaging (MRI) scans

An MRI scan can detect bleeding that is past 48 hours. MRI scan is very useful for assessing the condition of arteriovenous malformations , which is one of the causes of subarachnoid hemorrhage.

Lumbar Puncture

In some cases, the scan may not show any bleeding. In a lumbar puncture , the doctor will take a sample of the fluid protecting the brain between the vertebrae using a needle. In patients with subarachnoid hemorrhage, the fluid may contain blood.

Subarachnoid Hemorrhage Treatment

Bleeding makes the pressure inside the head increase. This risks causing brain damage to death. Therefore, the treatment is to monitor the increase in pressure in the head and address the causes of bleeding.

Pressure inside the head can be lowered with certain medications, such as:

osmotic diuretics, eg mannitol
Loop diuretics, namely furosemide
Intravenous steroids, such as dexamethasone

In addition, the doctor will also give a vasodilator called nimodipine to prevent narrowing of the brain's blood vessels, which usually occurs as a natural response to bleeding. This drug is important to use to prevent further brain damage.

If there is severe bleeding that risks pressing on the brain, the doctor will install a special tube through a head surgery method to reduce pressure. After that, the doctor can perform surgery to stop the bleeding, such as:

Neurosurgical clipping

Neurosurgical clipping aims to repair problematic blood vessels by clamping them with small metal clips. This procedure is performed through the craniotomy method (head surgery).

Endovascular coiling

In this procedure, the bulging blood vessel that forms a pocket due to the aneurysm is filled with platinum metal coils so that blood cannot pass through the bag. The purpose of this action is to reduce the risk of further bleeding.

To relieve accompanying symptoms and help with healing, patients can also be given other medicines, such as:

Blood pressure controllers, such as beta blockers
pain reliever
Antidepressants
Anticonvulsants , to prevent or stop seizures
Laxative, so as not to strain during bowel movements
blood vessel dilators, eg calcium antagonists.

Complications of Subarachnoid Hemorrhage

Subarachnoid hemorrhage that is not treated promptly can trigger the development of complications, such as:

Hydrocephalus , which is a buildup of fluid in the brain that can increase pressure in the head and damage the brain
Vasospasm, namely narrowing of blood vessels thereby reducing the flow of blood that carries oxygen to the brain
Recurrent bleeding
Strokes

In addition, sufferers are also at risk of experiencing the following long-term complications:

Epilepsy
Mood changes, such as depression
Disturbances in the cognitive function of the brain, such as concentrating, remembering, and planning things

Prevention of Subarachnoid Hemorrhage

Subarachnoid hemorrhage, especially nontraumatic, can be prevented by examining the potential for disorders in the brain, for example by early detection or treatment of brain aneurysms.

In addition, lifestyle changes are needed to eliminate risk factors for subarachnoid hemorrhage, such as: