Subarachnoid haemorrhage is characterised primarily by the fact that it leads to an extremely severe headache - patients who experience it often say that it is the most severe headache they have ever experienced in their lives. What are the causes of this life-threatening entity, what other symptoms of subarachnoid haemorrhage might there be and what treatment is given to patients in whom it occurs?
Table of contents:
- Causes of subarachnoid haemorrhage
- Symptoms of subarachnoid haemorrhage
- Diagnosis of subarachnoid haemorrhage
- Treatment of subarachnoid haemorrhage
Subarachnoid haemorrhage tends not to be mentioned very often, yet the problem is far more widespread than one might think - an estimated 3,000 cases of the condition are diagnosed in Poland each year. In general, subarachnoid haemorrhage is nothing more than a specific type of stroke - according to statistics, it accounts for around 5% of all cases of this entity.
Causes of subarachnoid haemorrhage
A subarachnoid haemorrhage occurs when blood starts to pool between the two meninges - the soft pia and the arachnoid pia. The most common cause is the rupture of an aneurysm located within one of the arterial vessels of the brain, but a haemorrhage can also be caused by the rupture of a hemangioma or arteriovenous malformation present in the structures of the central nervous system.
Aneurysms, hemangiomas and other lesions may be congenitaland usually, as long as there is no pathological process associated with them (e.g. rupture), patients with such formations are not even aware of it. The immediate implication here may be that it is therefore difficult to influence the risk of subarachnoid haemorrhage. However, the relationship is not so obvious and, ultimately, it appears that people with hypertension and advanced atherosclerosis have an increased risk of subarachnoid haemorrhage.
Symptoms of subarachnoid haemorrhage
The most characteristic symptom of subarachnoid haemorrhage is a headache. It is distinguished above all by the fact that it is extremely severe - in fact, it is mentioned in the literature that it is not uncommon for patients to declare that this was the most severe pain they have felt in their lives. The pain is sudden, usually unilateral and typically located in the neck or occipital region.
In addition to the headache, patients may complain of other possible symptoms of subarachnoid haemorrhage. These may include nausea, vomiting and hypersensitivity to various stimuli (usually sound and light). Seizures and disturbances of consciousness are also possible. If extravasated blood enters the cerebral hemispheres, other conditions such as sensory disturbances, paresis or speech disorders are also possible.
Subarachnoid ha emorrhage photo: panthermedia
Recognition of subarachnoid haemorrhage
A patient with a suspected subarachnoid haemorrhage needs specialist help as soon as possible, as this entity is life-threatening. It may seem difficult to conclude that indeed the headache the patient is experiencing may be a symptom of a haemorrhage - however, ultimately, this pain is indeed characteristic and should draw attention in particular when a person who has generally not complained of headaches before suddenly starts to experience extremely severe, intractable pain.
There are patients who suffer from chronic headaches, such as those who suffer from migraines. Here, it is worth noting that the pain associated with subarachnoid haemorrhage is usually different and patients are usually able to distinguish it from their 'typical' pain.
Ultimately, when subarachnoid haemorrhage is suspected, a neurological examination and head imaging studies are essential. On neurological examination, attention may be drawn in particular to neck stiffness, i.e. the inability to bring the chin to the chest when lying down. It is worth noting here that this symptom may occur even and only a few hours after the onset of subarachnoid haemorrhage, so not finding neck stiffness does not exclude the disease.
In the course of subarachnoid haemorrhage, damage to the cranial nerves may occur - in such cases, patients may develop such complaints as double vision, drooping eyelids or strabismus.
As mentioned above, imaging examinations of the head are essential in the diagnosis of subarachnoid ha emorrhage. Most commonly, a CT scan of the head is ordered to visualise the bleeding in the vast majority of cases. When a patient has symptoms of subarachnoid haemorrhage and the CT scan does not show signs of this entity, it is necessary to perform an examination of the cerebrospinal fluid, which is obtained during lumbar puncture.
It is worth emphasising here that the mere finding of a subarachnoid haemorrhage does not end the diagnostic process. If it is indeed confirmed, it is necessary to carry out tests to identify the cause of the haemorrhage, such as computed tomography angiography.
Treatment of subarachnoid haemorrhage
In patients with subarachnoid haemorrhage, one of the most important interventions is to stabilise their condition - to this end, patients are monitored, intubation is used if necessary. Another very important treatment step is the provision of a bleeding site, such as a ruptured aneurysm. Various procedures are used for this purpose, one of the most popular nowadays being endovascular embolisation of the aneurysm, in other words, closure of the bleeding structure.
The treatment of subarachnoid ha emorrhage is a rather complicated process - it is important not only to supply the bleeding structure, but also to reduce the risk of re-bleeding. Hypotensive drugs, i.e. drugs that lower blood pressure, are used for this purpose. It is also worth mentioning here that during treatment, measures should be taken to reduce the risk of its sequelae, which may develop, among other things, due to the shrinking of blood vessels. When vasoconstriction occurs, patients may suffer from limb paresis or speech disorders; to prevent such problems, patients are given nimodipine, which prevents vasoconstriction.
