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Subarachnoid hemorrhage

  • Alternative Names

    Hemorrhage - subarachnoid


    Treatment

    The goals of treatment are to save your life, repair the cause of bleeding, relieve symptoms, and prevent complications such as permanent brain damage (stroke).

    If the hemorrhage is due to an injury, surgery is done only to remove large collections of blood or to relieve pressure on the brain.

    If the hemorrhage is due to the rupture of an aneurysm, surgery is needed to repair the aneurym. If the patient is critically ill, surgery may have to wait until the person is more stable. Surgery may involve a craniotomy (cutting a hole in the skull) and aneurysm clipping, which closes the aneurysm, or endovascular coiling, a procedure in which coils are placed within the aneurysm to reduce the risk of further bleeding.

    If no aneurysm is found, the person should be closely watched by a health care team and may need repeated imaging tests.

    Treatment for coma or decreased alertness status may be needed. This may include special positioning, life support, and methods to protect the airway. A draining tube may be placed into the brain to relieve pressure.

    If the person is conscious, strict bed rest may be advised. The person will be told to avoid activites that can increase pressure inside the head. Such activities include bending over, straining, and suddenly changing position. The doctor may prescribe stool softeners or laxatives to prevent straining during bowel movements.

    Blood pressure will be strictly controlled. This requires medicines given through an IV line. The medicine often requires frequent adjustments. A medicine called calcium channel blocker is used to prevent blood vessel spams.

    Pain killers and anti-anxiety medications may be used to relieve headache and reduce intracranial pressure. Phenytoin or other medications may be used to prevent or treat seizures.


    Support Groups


    Expectations (prognosis)

    How well a patient with subarachnoid hemorrhage does depends on a number of different factors, including the location and extent of the bleeding, as well as any complications. Older age and more severe symptoms from the beginning are associated with a poorer prognosis.

    Complete recovery can occur after treatment, but death may occur in some cases even with aggressive treatment.


    Complications

    Repeated bleeding is the most serious complication. If a cerebral aneurysm bleeds for a second time, the outlook is significantly worsened.

    Changes in consciousness and alertness due to a subarachnoid hemorrhage may become worse and lead to coma or death.

    Other complications include:

    • Stroke
    • Seizures
    • Medication side effects
    • Complications of surgery

    Calling your health care provider

    Go to the emergency room or call the local emergency number (such as 911) you have symptoms of a subarachnoid hemorrhage.