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Subarachnoid Hemorrhage Treatment

State-of-the-Art Stroke Treatment Center

The Stroke Center at The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health provides high-quality care to patients presenting with head trauma, ruptured brain aneurysms, and stroke, including subarachnoid hemorrhage. Our interdisciplinary team of board-certified neurologists, neurosurgeons, and other healthcare professionals offer stroke treatment and we have treated even the most complex subarachnoid hemorrhages with the highest standard of care and compassion.

A subarachnoid hemorrhage, a type of brain bleed caused by a ruptured brain aneurysm which results in a stroke, is a medical emergency. If you suspect you are having a stroke, it’s extremely important to call 9-1-1 for immediate transportation to the hospital via ambulance. Every minute counts in treating a stroke, and you should not drive yourself to the hospital or allow someone else to drive you. The emergency medical service team in the ambulance will be able to provide life-saving treatment on route to the hospital.

What Is a Subarachnoid Hemorrhage (SAH)?

To understand what a subarachnoid hemorrhage is, it helps to learn basics about the anatomy of the brain. The compartment surrounding the brain is called the subarachnoid space, which is filled with cerebrospinal fluid (CSF) to cushion the brain inside the skull. The reason these brain bleeds are so dangerous is because they increase pressure on the brain and, by doing so, cause permanent brain cell damage.

Subarachnoid hemorrhage is a neurological disease affecting more than 30,000 people every year nationwide, according to a 2015 study by the National Institutes of Health. Subarachnoid hemorrhage is a type of stroke that can be caused by direct head trauma, a ruptured brain aneurysm, or a tangle of leaking blood vessels in the brain. Subarachnoid hemorrhages are rare, and encompass about 5 to 10% of all strokes.

A stroke is a serious medical emergency, and subarachnoid hemorrhage is fatal in about 40% of cases, according to the Brain Aneurysm Foundation.

What Causes a Subarachnoid Hemorrhage?

  • Traumatic brain injury: This is the most common cause of a subarachnoid hemorrhage. It occurs when the head is hit with blunt force and the brain crashes into the skull and tears the blood vessels, causing a brain bleed (stroke).

  • Burst brain aneurysm: An aneurysm is an artery with an abnormal bulge in a weakened part of the blood vessel. When it ruptures and leaks blood into the subarachnoid space surrounding the brain, it is a subarachnoid hemorrhage.

  • Arteriovenous Malformation (AVM): This rare condition involves an abnormal tangle of blood vessels which can rupture and bleed.

Risk Factors

The biggest risk factor is falling and hitting your head, as the majority of SAH sufferers are older adults. In younger individuals, SAH is often caused by motor vehicle accidents.

Subarachnoid Hemorrhage Symptoms

The most common signs of a subarachnoid hemorrhage include:

  • Sudden, severe headache, often described as the worst headache of one’s life

  • Nausea and vomiting

  • Stiff, sore neck

  • Light sensitivity

  • Blurred or double vision

  • Confusion

  • Rapid loss of alertness

The symptoms of a stroke can be remembered by this mnemonic/acronym, which can save your life or someone else’s if you act “FAST”:

  • F: Facial drooping

  • A: Arm Weakness

  • S: Speech difficulties

  • T: Time – this means you must seek immediate medical treatment should you notice these symptoms.

Subarachnoid Hemorrhage Diagnosis

An accurate, early diagnosis is crucial for the best outcome of a subarachnoid hemorrhage. The sooner a person is treated for a subarachnoid hemorrhage, the better odds of preventing permanent damage and saving lives.

  • Computed tomography (CT) scan: This imaging test is a simple, effective way to spot a subarachnoid hemorrhage inside the skull. Other tests may be ordered if the CT scan is negative.

  • Lumbar puncture: Also called a spinal tap, this procedure pulls a sample of cerebrospinal fluid (CSF) from the spinal cord. CSF is then tested for subarachnoid hemorrhage.

  • Angiogram: CT angiography (CTA) helps your neurologist visualize the blood vessels using a dye injected into a vein. This can be helpful if the CT scan misses a smaller subarachnoid hemorrhage.

  • Magnetic resonance imaging (MRI) scan: This imaging test can show if there has been bleeding in the brain in the recent past.

Brain Aneurysm: Subarachnoid Hemorrhage Treatment

When a subarachnoid hemorrhage is caused by a ruptured aneurysm, it can be treated surgically, either through an open or endovascular technique. Because the endovascular approach is less invasive, determining which treatment is best will depend on the characteristics of the aneurysm and the patient’s overall health.

Open surgical techniques include:

  • Clipping: Microsurgical clipping is done through craniotomy surgery. A craniotomy is performed by making an incision through the scalp to access the skull, and a piece of the skull is removed using a special, medical saw, so the neurosurgeon can access the brain. Once the brain is exposed, the neurosurgery team uses an intraoperative microscope to access the aneurysm and place a small clip around the neck of the aneurysm. Then, the portion of skull that was removed is replaced and fastened with plates and screws, and the incision is closed.

  • Vessel bypass: This surgery is also performed via craniotomy to access the aneurysm. Once the aneurysm is located, another blood vessel can be sewn onto the artery past the aneurysm, so blood can flow to the brain after the aneurysm has been secured.

Endovascular surgical techniques include:

  • Coiling: Also called endovascular embolization, this involves the insertion of a catheter into an artery in the groin to be threaded to the brain. Detachable platinum coils are then placed in the aneurysm, which reduces blood flow into the aneurysm sac and causes the blood to clot.

  • Stenting/flow diversion: Certain aneurysms are treatable with newer technology, such as stent- or balloon-assisted coiling to divert blood flow to another blood vessel in the brain.

Treatment for Complications of a Subarachnoid Hemorrhage

Most patients stay in the hospital after having surgery for at least 10-20 days to ensure they recover as smoothly as possible.

  • Vasospasm: After a brain aneurysm ruptures, it can cause the arteries to narrow because of local inflammation. This is called a vasospasm and, if significant, causes the blood vessels to clamp down and reduce or stop blood flow to parts of the brain, resulting in a second stroke. When vasospasms develop, it is usually between the 7th and 10th day after the subarachnoid hemorrhage. Vasospasm is difficult to treat, so the focus is on prevention. A vasospasm is treated by close neurologic monitoring, medication, and maintaining hydration.

  • Hydrocephalus: Bleeding from a subarachnoid hemorrhage can cause the brain to swell. This life-threatening condition is caused by an excess of cerebrospinal fluid (CSF) in the brain. The treatment for hydrocephalus is to drain the excess fluid with the insertion of a shunt, called an external ventricular drain, which is left in place for 1 to 2 weeks.

  • Seizures: A seizure may result if blood irritates the cerebral cortex, which can cause shaking in one or areas of the body. Patients are given medication to prevent seizures at the onset of a subarachnoid hemorrhage.

  • Rebleeding: There is a risk of rebleeding after a subarachnoid hemorrhage. In fact, the risk is about 3-13% within the first 24 hours, according to a 2012 article in Stroke. To prevent rebleeding, high-risk aneurysms are clipped or coiled off in a surgical procedure.

Request an appointment online now or call 833-656-3876.