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Subarachnoid haemorrhage.

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VOL: 101, ISSUE: 02, PAGE NO: 30

What is it?


What is it?
- Subarachnoid haemorrhage occurs when an artery under the arachnoid mater membrane surrounding the brain ruptures and blood leaks into the cerebrospinal fluid.



- The condition is potentially life-threatening and requires urgent medical attention.



- Subarachnoid haemorrhage is more common in women and older people (Brain Australia, 2003).



- Most subarachnoid haemorrhages are caused by a ‘berry’ aneurysm at a junction in the blood vessels.



- Berry aneurysms are present in about one per cent of the population, although only a very small proportion of these rupture.



- Arteriovenous malformation - a tangled mass of blood vessels linking arteries and veins present from birth - is a less common cause of subarachnoid haemorrhage.



- Smoking, hypertension and an alcohol consumption of >150g per week have been associated with increased risk of subarachnoid haemorrhage.



- Excruciating headache, usually of sudden onset, often at the back of the head.



- Nausea and vomiting.



- Tiredness.



- Loss of consciousness.



- Seizures.



- Confusion.



- Other symptoms may include stiff neck and aversion to bright light.



- Symptoms vary and depend on the severity of the haemorrhage. They are often similar to those associated with meningitis.



- Initial diagnosis is usually based on the characteristic symptoms.Other tests are used to confirm the diagnosis and decide on treatment options. These include:



- Computerised tomography (CT) scan to show the source and quantity of bleeding; l Magnetic resonance imaging (MRI) and/or angiogram to locate the berry aneurysm if this is the cause of the haemorrhage; l Lumbar puncture to examine cerebrospinal fluid for the presence of blood.



- Subarachnoid haemorrhage is an emergency and the patient must be transferred to hospital immediately.



- The timing of surgery depends on the patient’s condition.



- If the cause of haemorrhage is a berry aneurysm, craniotomy is usually required to seal off the aneurysm and prevent future bleeds.



- Alternatively, the aneurysm may by accessed arterially through a procedure known as endovascular embolisation or coiling.



- If the haemorrhage is due to arteriovenous malformation this will be removed by craniotomy.



- Some patients have additional aneurysms and may need further surgery to prevent future bleeds.



- Drugs will be prescribed as necessary for analgesia, to reduce the risk of vasoconstriction, control seizures or decrease blood pressure.



- Aneurysm rupture is fatal in 40 per cent or more cases.



- Half of survivors experience stroke-like deficits such as speech disturbance, weakness on one side of the body or double vision.



- Vasospasm in the days following haemorrhage may result in stroke.



- Postoperative jaw stiffness, headaches, pain or numbness around the scar may be experienced temporarily but should decrease.



- Occasionally epileptic seizures or hydrocephalus may occur.



- Intensive physical, occupational and speech therapy will help, but recovery may be slow and uneven.



Website: NHS Direct:

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