Subarachnoid Hemorrhage: Defintion, Symptoms, Diagnosis, Treatments and Complications

Subarachnoid hemorrhage is one type of stroke that occurs due to bleeding in the subarachnoid space, which is in the protective layer of the brain or meninges, due to rupture or damage to blood vessels in the meninges membrane. 

The meningeal membrane consists of three layers of tissue, namely the dura mater, arachnoid and pia mater layers.

The subarachnoid space is located between the arachnoid and pia mater layers. This space contains cerebrospinal fluid which plays a role in protecting the brain and spinal cord, and contains many blood vessels that function to carry nutrients and oxygen to the brain. 

If these blood vessels rupture and cause bleeding in the subarachnoid space, it can cause damage to the brain resulting in paralysis, coma, or even death.

Subarachnoid hemorrhage can occur as a result of trauma or head injury or without trauma (occurs spontaneously). Subarachnoid hemorrhage that occurs not due to head trauma can be caused by a brain aneurysm or abnormalities of the arteries and veins in the meninges membrane. 

To avoid complications and death, patients with subarachnoid hemorrhage should seek medical attention immediately when symptoms of bleeding appear.

Symptoms of Subarachnoid Hemorrhage

Subarachnoid hemorrhage can occur without certain symptoms felt by the patient. However, in some cases, symptoms will appear after strenuous physical activity. 

The main symptom felt by sufferers is a severe headache that appears suddenly and has never been felt before. Other symptoms include:

  • Neck feels stiff.
  • Nausea and vomiting.
  • Pain in the shoulder area.
  • Blurred, double vision, or sensitivity to light.
  • Experiencing stroke symptoms, such as slurred speech and paralysis on one side of the limb.
  • Decreased consciousness.
  • Seizures.

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

If you find someone experiencing the symptoms of subarachnoid hemorrhage as above, immediately seek help from a doctor or medical officer.

Cause Subarachnoid Hemorrhage

Causes of subarachnoid hemorrhage can be divided into two, namely traumatic and non-traumatic. Traumatic subarachnoid hemorrhage occurs as a result of a severe head injury, such as a traffic accident, a fall, or an object hit to the head. This severe injury can cause blood vessels in the meningeal membranes to rupture and cause subarachnoid hemorrhage.

Subarachnoid hemorrhage can occur without being preceded by injury and appear suddenly. The most common cause of non-traumatic subarachnoid hemorrhage is rupture of a brain aneurysm. 

Aneurysms in the blood vessels of the brain cause swelling and thinning of the vessel walls. Blood vessels that are thinned by an aneurysm can rupture and cause bleeding, and form blood clots in the subarachnoid space of the meninges. 

Non-traumatic subarachnoid hemorrhage can also occur due to blood vessel abnormalities (venous artery malformations), consumption of blood-thinning drugs, and blood clotting disorders.

A person can more easily experience a subarachnoid hemorrhage if they have factors, such as:

  • Smoking habit.
  • Hypertension.
  • Alcohol addiction.
  • Family history of subarachnoid hemorrhage.
  • Polycystic kidney disease.
  • Liver disease.
  • Brain tumors, both malignant and benign, that affect blood vessels.
  • Infection of the brain (encephalitis).
  • Fibromuscular dysplasia , which is a rare condition that causes narrowing of the blood vessels.
  • Moyamoya disease, which is a rare condition that causes blockages in the blood vessels in the brain.
  • Inflammation of the blood vessels (vasculitis).

Subarachnoid Hemorrhage Diagnosis

The first stage of diagnosis of subarachnoid hemorrhage by a doctor is to examine the symptoms that arise in the patient. The doctor will check if the patient complains of severe headache, visual disturbances, and a stiff neck as the main symptoms of a subarachnoid hemorrhage. 

If the doctor suspects that the patient is suffering from a subarachnoid hemorrhage, the doctor will recommend the patient to undergo a follow-up examination.

To diagnose a subarachnoid hemorrhage, the doctor will ask the patient to undergo a CT scan. CT scans can provide a visual image of the condition of the blood vessels, both with the aid of contrast and without the aid of contrast. To see the blood vessels more clearly, it is necessary to do a CT scan angiography.

If needed, the doctor may ask the patient to undergo an MRI examination to look for subarachnoid hemorrhage. MRI can also map the condition of blood flow in the area of ​​the meninges membrane that is suspected to be bleeding.

In some cases, a CT scan cannot detect bleeding. To ascertain whether the patient megalami subarachnoid hemorrhage, after undergoing a CT scan, the patient may be asked to undergo a spinal tap ( lumbar punc ure ). 

Lumbar puncture aims to take a sample of cerebrospinal fluid using a needle in between the spine to check the presence of blood in the cerebrospinal fluid as a marker of subarachnoid hemorrhage.

Patients can undergo several examinations, both scans and lumbar puncture tests to determine whether there is a subarachnoid hemorrhage or not. If it is confirmed that the patient has a subarachnoid hemorrhage, the doctor will plan treatment.

Subarachnoid Hemorrhage Treatment

The main treatment for patients with subarachnoid hemorrhage is to ensure that vital signs, such as breathing and heart rate are safe, for example by installing a breathing apparatus. Further treatment is needed to stop the bleeding and reduce the pressure inside the head that can cause damage to the brain.

To stop the bleeding, the doctor will look for causes, such as bleeding that occurs due to a ruptured brain aneurysm. To treat a subarachnoid hemorrhage due to an aneurysm, the patient will undergo a surgical procedure. Among others are:

  • Endovascular coilingIn this procedure, the aneurysm sac will be filled with platinum metal coils, so that blood does not pass through the bag, which is at risk of rupture. This procedure is used more often because it has a lower risk of short-term complications. Patients are usually allowed to leave the hospital sooner, and the duration of recovery tends to be faster.
  • Neurosurgical clippingThis procedure is performed by clamping the problematic blood vessels with metal clips. The clipping procedure isperformed using the craniotomy method or head surgery, in which the patient is unconscious due to general anesthesia. The blood vessels that have been clamped will repair, and the aneurysm that occurs will be permanently blocked.

If there is an increase in pressure in the head, the doctor will install a special tube, through the surgical method of the head, to reduce the pressure. In addition to surgery, patients with subarachnoid hemorrhage can also be given drugs to relieve symptoms and help healing, such as:

  • Blood pressure controller. For example, beta blockers.
  • Pain and anxiety relief.
  • Anticonvulsants, to prevent or stop
  • Laxative, so as not to strain when defecating.
  • Vascular dilators, eg calcium antagonists.

The healing process can be depressing, so sufferers will need support from family and friends. The location and severity of subarachnoid hemorrhage will also affect the appearance of disorders in the area experiencing this condition.

The following are some of the post-subarachnoid hemorrhage effects that can be experienced during the healing process:

  • Sleep disturbances or insomnia. Generally, patients with subarachnoid hemorrhage are only able to sleep for a short time.
  • Headache. Patients can handle this by consuming plenty of fluids and pain medication if needed.
  • Feeling very tired. Patients with subarachnoid hemorrhage can feel very tired even if they only do light activities. Overcome by taking short breaks every half hour, three times a day, after activity.
  • Strange sensations such as a cold and tingling sensation in the head.
  • Changes in the sense of taste and, but will return to normal after the pressure in the head is reduced.
  • Blurred vision, double vision, or seeing black dots.
  • Can’t feel or move body or arms, and can’t tell the difference between cold and

Subarachnoid Hemorrhage Complications

Subarachnoid hemorrhage that is not treated immediately can lead to the development of complications.

Main complications:

  • Narrowing of the blood vessels of the brain resulting in reduced blood supply to the brain which can cause damage to the brain. Symptoms resemble stroke, to coma.
  • Recurrent bleeding. This condition must be treated immediately because it can risk permanent damage or even death.
  • Hydrocephalus, which is the accumulation of fluid in the

Long term complications:

  • Epilepsy.
  • Mood swings, such as depression.
  • Disorders of the brain’s cognitive functions, such as concentration, memory, and planning.

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