Subarachnoid Hemorrhage: A Rational Approach

SmartEm Research Team
December 18, 2010

In October of 2010 the prestigious British Medical Journal published the largest, and by far the best, study ever done on the diagnosis of SAH in the ED. The data are revolutionary, and they prompted us to take a new look at the classic teaching and modern approach to this diagnosis.

It’s always fun to deep dive on a new topic, and we hoped to combine the newest data with the classic data to find a safe, rational, and smart approach to the evaluation of high risk headache. What we found was more earth shaking than we could have imagined. Come take a journey to the center of the data, new and old... this changes everything.

What Is a Subarachnoid Hemorrhage?

A subarachnoid hemorrhage, more commonly called a bleeding in the brain or a stroke, occurs when an artery in the head bursts and bleeds into the space surrounding the brain. This space is made up of fluid that cushions your brain from impacts to help protect you, but this also makes it difficult to repair the damage that results from bleeding into this space.

You may experience a subarachnoid hemorrhage if there is risk for a cerebral aneurysm, which is where an artery in your brain becomes enlarged like a balloon instead of its normal shape.


The causes of this condition could be from a variety of factors.

Subarachnoid Hemorrhage is most commonly caused by trauma to the head, but it can also result from aneurysms or arteriovenous malformations.

Other causes include hypertension (high blood pressure) and vasospasm; brain trauma is rare as a cause for Subarachnoid Hemorrhage.

The most common cause of Subarachnoid Hemorrhage is the rupture of an intracranial (or intra-parenchymal) aneurysm. These are weak points in the walls of arteries that can swell and break easily, causing bleeding and pressure on nearby tissues in the brain.

The majority of these types of Subarachnoid Hemorrhage happen while people are sleeping and the bleeding begins, going unnoticed until something happens to alert them or their bodies start experiencing some of the symptoms below.


Subarachnoid Hemorrhage can affect anyone; some of the most common risk factors for Subarachnoid Hemorrhage are hypertension and smoking.

It is important to remember that there are many risk factors for Subarachnoid Hemorrhage, so it is essential that you take care of your health and make sure to keep up on any treatments from doctors. If you are pregnant or plan to become pregnant soon, talk with your doctor about what the risk factors are for this condition and how they can affect your pregnancy.

The risk for having a Subarachnoid Hemorrhage increases with age. It affects about 10 people in every 100,000 younger than 45 years old and about 32 in every 100,000 middle-aged people between the ages of 45 and 65 years.


The most common symptoms for Subarachnoid Hemorrhage are the sudden onset of severe headache, nausea and vomiting, altered mental states like confusion or delirium, drowsiness and disorientation.

The blood in the brain can cause pressure on different parts of it as well, which leads to other symptoms like seizures (more common for younger people), weakness or paralysis on one side of the body, changes in vision or double-vision and a loss of consciousness.

A Subarachnoid Hemorrhage has many symptoms that you should watch out for whenever it strikes, so you can get to the hospital fast enough and get treatment before permanent damage sets in.

The symptoms of a Subarachnoid Hemorrhage include: blackouts, confusion, difficulty with breathing, double vision, headache, seizures or convulsions.

If you or someone you know experiences any of these symptoms, get to the emergency room immediately; do not try to drive yourself or let yourself be taken by a friend to the hospital.


After being diagnosed with Subarachnoid Hemorrhage, the most important thing to remember is that there is no treatment option for this condition yet. Doctors are still researching and trying to figure out what works best to treat Subarachnoid Hemorrhage in order to help patients recover from this ailment and prevent further damage.

There is a very low survival rate for Subarachnoid Hemorrhage. Both the death rate and the disability rate are higher for patients who get this condition than those who do not.

If you are diagnosed with Subarachnoid Hemorrhage, you and your family have to stay positive and hope for the best. If you take care of yourself, eat right, drink plenty of water and exercise regularly then there is a much better chance that you will recover fully from this condition than if you do not take such good care of yourself.

When going to your doctor for check-ups, make sure that you always tell the staff what medications you are taking and what illnesses you have suffered from in the past so they can be on alert for any changes in your health.


The best treatment for Subarachnoid Hemorrhage is around-the-clock care by a medical team in the hospital. The longer you wait to seek treatment, the more damage will occur and recovery will be slower.

The main treatment for Subarachnoid Hemorrhage is surgery to repair the aneurysm; if this isn't possible (for example, if the aneurysm ruptured when the patient was sleeping), then you can get treated with medications like vasodilators to prevent vasospasm, anticonvulsants or antihypertensive medications.

You may need to have a shunt put in place so you can drain excess blood and fluid from your brain, you might require surgery to ease pressure on the brain tissues that are affected by the Subarachnoid Hemorrhage, you may need to receive fluids and blood transfusions, anti-seizure medications or even have a feeding tube if you cannot gain weight.

If the aneurysm ruptures, it can be repaired with surgery and can prevent further bleeding. Sometimes if the aneurysm ruptured when the person was sleeping, there is no surgery possible and doctors will treat the patient with medications to prevent vasospasm and anticonvulsants.

Vasodilators work by opening up the blood vessels to help diminish pressure on the brain tissues, which stops or slows bleeding.


You are likely to regain consciousness within a few days after the Subarachnoid Hemorrhage but will probably spend time in intensive care while recovering from surgery and any other problems that may arise. The recovery process for Subarachnoid Hemorrhage can take anywhere from weeks to months, depending on what complications arise and how severe the brain damage is.

Keep in mind that stroke victims may suffer permanent disabilities as a result of Subarachnoid Hemorrhage; children and teenagers are also susceptible to long-term disabilities if this condition occurs before they turn 22.

It is vital that you take care of yourself and ensure you are in the best physical and emotional state possible so you will be able to handle any symptoms that may arise; as a result, most people who suffer Subarachnoid Hemorrhage are above 40 years old.

Final Thoughts

If you ever find yourself struggling with Subarachnoid Hemorrhage, chances are it will occur during your fifties and early sixties; just remember that the world is looking into ways to help you with this condition.

The most important thing about Subarachnoid Hemorrhage is that there are many risk factors associated with it, so it is important to practice preventative measures and take care of yourself.

Also, remember that there is currently no treatment for Subarachnoid Hemorrhage; you are simply left to deal with the aftermath of this condition and hope for the best as doctors try to find a way to treat it so you can fully recover from this ailment.

Copyright © 2020. All rights reserved. Sitemap