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Subarachnoid Haemorrhage: The Brain Bleed

Subarachnoid haemorrhages where first reported in 1814. A subarachnoid hemorrhage, also known as SAH is a type of stroke that is life-threatening. The subarachnoid space is in between your brain’s arachnoid membrane and pia mater; the term hemorrhage is actually Greek for “violently bleeding”.

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The process of SAH occurs when you have blood in your Subarachnoid space; it can be due to the rupturing aneurysm, a type of head injury, or an arteriovenous malformation also known as AVM. If at this point you are wondering, “Can I get SAH?” the answer is yes, anyone can be affected by SAH; that being said, it is most common in women, people that suffer high blood pressure, anyone between the ages of 40-65, and smokers (Kristeen Moore, 2017). Many people go their whole life with an aneurysm and they never know because it never ruptures or affects them in any way.

The signs and symptoms of SAH are very sudden quick. According to an article on Healthline written by Kristeen Moore, the patient will experience: (2017), “sudden, severe headache… a popping sensation in their head before the hemorrhage begins, neck pain, numbness, shoulder pain, seizures, confusion, irritability, sensitivity to light, decreased vision, double vision, nausea, vomiting, and rapid loss of alertness” (para. 5). If you experience these symptoms your only option is to immediately go to the hospital, as these symptoms can be life-threatening.

Due to the fact that SAH is sudden, the diagnosis process is very quick; that being said, it is crucial for doctors/nurses to get as much information about the patients’ family and medical history as quickly as possible. To determine the origin of the bleeding they will go posthaste to perform an Angiogram, MRI or MRA, Lumbar puncture, or CT scan. It is of the upmost importance to follow these procedures quickly, as it is a life or death situation.

To treat SAH, surgery will be performed; the two types of surgeries available thus far are craniotomies in which the aneurysm is clipped, or a less invasive procedure, endovascular coiling, grafting, or stenting. As far as a cure, surgery is unfortunately the only thing that can stop the bleeding. Pain medication will be given to the patient for the intense headache, anticonvulsants alongside it to prevent to prevent the patient from going into a seizure, as well as a medication to lower the patients blood pressure in a case where it is too high.

After SAH surgery you will be admitted into the hospital for intensive care due to the possibility of complications. The first week after the surgery is critical because the brain is trying to absorb the blood that came out of the blood vessel/s. The hospital stay varies based on the patients’ condition but can be anywhere between 10-20+ days due to the possibility of vasospasms, convulsions, and strokes.

Fortunately, SAH can be prevented if you find the aneurism before it ruptures. In some cases, the doctor will treat it with an endovascular treatment involving grafts, stents, or coils if it even needs to be treated. It is important to note that smoking, stress, and high blood pressure has been linked to the development of aneurysms. It is also important to note that 1/3rd of patients don’t even make it to the hospital alive, the other 1/3rd suffer severe impairments and can end up brain dead, and the final 1/3rd make a phenomenal recovery with barely any complications that impair the patient, if any.

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While researching SAH I came across a peer-reviewed journal on PubMed in relation to neurocritical care; it suggested that neurocritical care is improving, maturing and growing. The journal stated that (Curr Opin Crit Care, Moheet A.M., Livesay S.L., 2020), “The quality improvement movement is gaining momentum in neurocritical care with evaluation of general medical and surgical critical care quality improvement approaches in this specific patient population” (para. 3). This is a big deal in the medical field because the more they improve as a field, the less fatal these neurological issues such as SAH become.

Reverting back to what I stated earlier about smoking and high blood pressure being linked to the development of aneurysms, a different PubMed journal agreed. This journal stated (Neurology, Lindbohm J.V., Kaprio J., Korja M., 2019), “Smokers had reduced survival compared to that of never-smokers… and those with high systolic blood pressure (SBP) (≥160 mm Hg) had reduced survival when compared to survival of those with SBP <160 mm Hg… CONCLUSIONS: After aSAH, smoking and hypertension were associated with worse survival” (para. 3 and 4). That being said it is important to inform the public and educate not only smokers and people who suffer from high blood pressure, but also young people who don’t typically get informed on matters such as this. I for one did not know anything about this subject until my grandmother experienced her aSAH and I wish I would have known sooner so that I could try to prevent it from getting as bad as it did.

My grandmother was 67 years old when she experienced her aSAH (Aneurysmal Subarachnoid Hemorrhage). She had just lit a candle in honor of her mother who passed away that day six years ago, she proceeded to call her twin brothers to wish them a happy birthday when all of a sudden her vision got blurred; she then experienced what she now calls “The worst headache of her life” (Pagan M., personal communication, February 19, 2020), and started projectile vomiting. At that point the ambulance had been called and she was taken to St.Mary’s Medical Center where she underwent emergency endovascular surgery using coils to stop the bleeding. She stayed in the hospitals Neuro-ICU for 25 days where she suffered from extreme vomiting and headaches, sensitivity to light, and ICU delirium. Fortunately she was the 1/3rd to walk out of the hospital with no complications that impaired her. Unfortunately she still smokes to this day but claims she smokes a lot less than before; she believes that she rather die happy doing what she loves because when it’s her time, it’s her time and she’s going to die anyways.

Lastly, I watched a video about a woman named Louise; she was at the gym when she lifted a weight and had an aSAH. Loise described it as an “excruciating pain at the base of my neck come over the top of my head” (Zahra K. [Cleveland Clinic Abu Dhabi]. (2019, December 17). Subarachnoid Hemorrhage – Louise’s Treatment & Recovery Story). Louise was rushed to the Cleveland Clinic where she was given emergency endovascular surgery. Fortunately she was also one of the 1/3rd’s to have the ability to walk out of the hospital with no complications that impaired her. Louise was able to get back to her normal routine and continue doing the things she loved.


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