Subarachnoid hemorrhage is a type of stroke that occurs due to bleeding in the subarachnoid chamber, which is in the protective layer of the brain or meninges, due to rupture or damage to blood vessels in the meninges membrane. The meninges membrane consists of three layers of tissue, namely the duramater layer, the arachnoid layer, and the piamater layer.
The subarachnoid space is located between the arachnoid and piamater layers. This space contains cerebrospinal fluid that plays a role in protecting the brain and spinal cord, and contains many blood vessels that serve to carry nutrients and oxygen to the brain. If the blood vessels rupture and cause bleeding in the subarachnoid chamber, it can cause damage to the brain, resulting in paralysis, coma, or even death.
Subarachnoid Hemorrhage Risk Factors
There are several risk factors that can trigger a subarachnoid hemorrhage, such as:
- High blood pressure (hypertension).
- Polycystic kidney disease or liver disease.
- Excessive alco**hol consumption.
- Infection of the brain.
- Brain tumor.
- There is a history of subarachnoid hemorrhage in the family.
Subarachnoid Hemorrhage Causes
Most cases of subarachnoid hemorrhage are caused by trauma to the head. In addition, the rupture of an aneurysm in the brain or Berry Aneurysm, is also closely related to subarachnoid hemorrhage that occurs suddenly (without head trauma).
An aneurysm is an abnormality in the blood vessels when blood vessels are dilated due to weak walls. This brain aneurysm is quite serious, because when it breaks and bleeds, blood clots can occur very quickly. Although it can occur at all ages, but the rupture of an aneurysm is most common in people aged 40 to 65 years.
Other causes of subarachnoid hemorrhage include:
- Bleeding due to arterial-venous malformations in the brain.
- Use of blood thinning drugs (in patients with heart disease).
Subarachnoid Hemorrhage Symptoms
The main signs and symptoms of subarachnoid hemorrhage are sudden severe headaches (thunderclap headache). These symptoms often feel bad in the back of the head (back headache). In fact, many people describe it as the “worst headache” and in contrast to other types of headaches.
Other symptoms include:
- Awareness and alertness decrease.
- Eye discomfort to blinding light (photophobia).
- Changes in mood and personality, including confusion and quick anger.
- Muscle pain (especially the neck, shoulders, or back pain).
- Nausea and vomiting.
- Weakness or numbness in part of the body.
- Stiff neck.
- Difficulty speaking.
- Vision problems, including double vision, visible spots, or temporary vision loss in one eye.
Before a subarachnoid hemorrhage occurs, you may experience other symptoms associated with a brain aneurysm, such as pain around the eyes, changes in pupil size, hearing loss or balance problems, or difficulty with memory. However, some people with brain aneurysms may not feel any symptoms.
Some other symptoms or signs may not be listed above. If you feel anxious about these symptoms, consult your doctor immediately.
Subarachnoid Hemorrhage Diagnosis
The doctor will diagnose subarachnoid hemorrhage (SAH) through a physical examination and will usually find stiff neck conditions as well as visual impairment. A typical main symptom is severe and sudden headaches, which can also lead to SAH.
Other supporting examinations such as magnetic resonance imaging (MRI) and computerized tomography (CT-scan) are performed to assist with SAH confirmation. Other examinations such as brain angiography using X-rays and contrast, as well as transcranial ultrasound are performed to check blood circulation in the brain. The lumbar function examination is also commonly done to check for the presence of red blood cells in cerebrospinal fluid (CSF).
Subarachnoid Hemorrhage Treatment
Ways of treating subarachnoid hemorrhage can include measures to save a patient’s life, relieve symptoms, repair ruptured blood vessels, and prevent complications. Treatment of this condition focuses on stabilizing the patient’s condition, and is carried out based on the cause of bleeding as well as the degree of brain damage that occurs. Here’s the explanation:
Treatment of a ruptured brain aneurysm
If the bleeding is caused by a ruptured brain aneurysm, the doctor will suggest the following treatment efforts:
The doctor will make an incision in the lining of the skull and will place a metal clip on the end of the aneurysm to stop the blood flow.
The surgeon will insert a catheter in the arterial blood vessels in the groin directed towards the brain. The stretch formed from platinum is inserted through the catheter until it reaches the aneurysm. This stretch fills the aneurysm and will reduce blood flow to the aneurysm bag causing blood to clot.
Other endovascular techniques
Certain aneurysm can be treated with other endovascular techniques, such as using stents or balloons that divert blood flow.
If subarachnoid hemorrhage causes coma, treatment uses life support tools such as ventilators, airway protection, and hose placement to remove fluid from the brain so that pressure on the brain is reduced.
Medications can be given to regulate blood pressure and prevent narrowing of arterial blood vessels (nimodipine). In addition, pain relievers can relieve symptoms of severe headaches.
Endovascular procedures sometimes need to be performed repeatedly. Monitoring will be done regularly by the doctor to see the changes. Patients may require physical therapy, occupational therapy, or speech therapy.