Neurocritical Care

NCC Q&A - Subarachnoid Hemorrhage

What causes subarachnoid hemorrhage?
Subarachnoid hemorrhage is often caused by an aneurysm on a blood vessel that ruptures.  An aneurysm is an outpouching on a blood vessel whose walls get weak as it enlarges. 

What are symptoms of a ruptured aneurysm?
Symptoms of a ruptured aneurysm can include sudden onset of a severe headache, nausea, vomiting, sensitivity to light, neck pain and stiffness. 

How is subarachnoid hemorrhage diagnosed?
When patients present to the hospital with symptoms concerning for subarachnoid hemorrhage, a CAT scan of the head often makes the diagnosis.  Sometimes, if it is more than 48 hours from symptom onset, a lumbar puncture (spinal tap) may need to be done to make the diagnosis.
When the diagnosis is made of subarachnoid hemorrhage, patients need to be admitted to the hospital, in the intensive care unit for close monitoring.  Further testing is done to find the precise location of the aneurysm.  An angiogram is a common test done to both locate and sometimes, treat the aneurysm as well.  During an angiogram, a catheter is inserted into an artery in the leg and carefully threaded up to the blood vessels brain.  Dye is used to carefully evaluate the blood vessels.  If an aneurysm is found and has certain characteristics for endovascular repair, small coil can be placed within the aneurysm to allow it to seal off.  If the aneurysm is not appropriate for endovascular repair, an operation is performed (craniotomy) to place a clip at the base of the aneurysm.

What types complications can result from subarachnoid hemorrhage?
When patients have subarachnoid hemorrhage, they need close monitoring in an intensive care unit.  Blood in the subarachnoid space of the brain can cause increased pressures within the brain.  Sometimes, patients need a catheter that helps drain fluid within the brain as this helps relieve the pressure.  As blood is an irritant to the brain, patients are also at risk of developing seizures or vasospasm.  Vasospasm is when brain blood vessels constrict, limiting blood flow and making patients at risk for strokes.
When a ruptured aneurysm causes a large amount of subarachnoid blood, patients can have a decrease in their level of alertness.  Sometimes patients can require a breathing tube and assistance of a ventilator.  When patients require a ventilator they are usually on medication for comfort.  These medications can often make patients sleepy.

How long do patients need to stay in the hospital?
Treatment for subarachnoid hemorrhage in the ICU is often 10-14 days.  It can be more depending on the severity of the patient’s condition.