If you have a severe headache that’s accompanied by loss of consciousness, confusion or other signs of a stroke, seek emergency medical attention. It’s important to get help as quickly as possible because a bleed in the brain can cause permanent damage.
Most spontaneous subarachnoid hemorrhages are caused by ruptured aneurysms. They can be present at birth (congenital) or develop later, when high blood pressure weakens the walls of arteries.
The most common cause of subarachnoid hemorrhage is a burst blood vessel in the brain (aneurysm). Bleeding occurs into the space between the inner layer (pia mater) and middle layer (arachnoid mater) of the tissues covering the brain (meninges). The blood collects in this area, which causes high pressure within the skull. This can damage cells and may lead to lifelong problems or death. The most serious symptom is a sudden, severe headache called a thunderclap headache. This is a sign of the condition and should prompt immediate medical care.
A health care provider will use a physical exam and may order a blood test to check your blood counts. Other diagnostic tests include a CT scan and an MRI. A CT scan uses X-rays and a computer to make horizontal (axial) images of your head and brain. During an MRI, radio waves and large magnets send signals to make detailed pictures of your brain without using X-rays. During a CT angiogram, a health care professional injects dye into your blood vessels, which helps them show up on a picture of your brain. A health care provider will then look for blood vessels in your brain that are bleeding and may measure your cerebrospinal fluid pressure.
If a subarachnoid hemorrhage has occurred, your health care provider will probably transfer you to a neurosciences unit. You will be given medicines to prevent short-term complications, and a procedure to repair the aneurysm may be done.
Long-term complications of a subarachnoid hemorrhage include physical problems such as drowsiness and weakness, numbness or tingling in parts of your body and difficulty swallowing and moving your legs. You also may have cognitive issues, such as memory problems and trouble thinking clearly. Seizures are another possible problem, and some people with SAH become depressed or anxious.
Some people who have a subarachnoid hemorrhage recover completely with no long-term effects. Others may have problems such as depression, difficulty thinking clearly or making decisions, and trouble with balance and movement. These problems can be treated with medicine and therapies such as physical therapy, speech therapy, and occupational therapy.
A subarachnoid hemorrhage (SAH) happens when there’s bleeding in the space between your brain and the thin tissues that cover and protect it. SAH can be caused by head trauma, an aneurysm or a brain tumor.
Your doctor will diagnose SAH by taking your medical history and doing a physical exam. You’ll have a CT scan to see if you have a bleed. A CT scan is very useful, because it shows the bleed and helps doctors decide what treatment is best.
In about 95 percent of cases, a CT scan detects SAH. The scan can also show if the blood is coming from a large aneurysm or from a traumatic injury, and it can help find out why the aneurysm bled. A type of CT scan called a computed tomography angiogram can pinpoint the source of the bleed in about 85 percent of confirmed cases.
If you have a CT scan and a small bleed, your doctor may do a spinal tap to test the fluid that surrounds your brain and spine (cerebrospinal fluid). A spinal tap isn’t done if the pressure within your skull is high enough to make the procedure dangerous.
The spinal tap can also show whether you have a condition that affects hormone production and balance (hypopituitarism). It can be caused by damage from a SAH to the hypothalamus or pituitary gland. It’s more common in people with a history of aneurysmal SAH.
Other symptoms may include neck stiffness and pain, numbness or weakness in parts of your body, problems with your balance, and changes in how you think or speak. Some people have a “thunderclap” headache that comes on very suddenly and is very painful. This headache usually goes away on its own.
Hemorrhage from a ruptured aneurysm can lead to permanent brain damage, and some people die during or soon after a SAH. The prognosis depends on how bad the bleed is and when you get treatment. Follow-up care is important to help you regain function and cope with emotional or cognitive problems. This may include physical therapy, speech therapy and occupational therapy. You should also quit smoking and limit how much alcohol you drink. You should get regular screening for aneurysms if you have a family history of them.
A subarachnoid hemorrhage is a medical emergency because it causes symptoms that can be life threatening. It is important to get to a hospital quickly so that treatment can begin before brain damage occurs.
The first thing that your doctor will do is give you a CT scan of the head. A CT (computerized tomography) scan uses X-rays and a computer to form detailed images of organs and structures inside your body, including your brain. A CT scan is the best way for your doctor to identify the cause of your subarachnoid hemorrhage and see if there is any additional damage that needs to be treated.
If a CT scan doesn’t show a subarachnoid hemorrhage but your symptoms suggest that you have one, your doctor may do a test called a lumbar puncture or spinal tap. During this test, a needle is inserted into your lower back and a small amount of cerebrospinal fluid, or CSF, is removed and examined for blood.
Other tests that your doctor might order include an MRI of the brain or brain angiography. These tests use a contrast dye to visualize blood vessels in your brain and may help detect an aneurysm or arteriovenous malformation (AVM).
A complication of a subarachnoid hemorrhage that is common with an aneurysmal rupture is delayed spasm of the blood vessels of the brain (cerebral vasospasm). This can decrease blood flow to parts of the brain and lead to strokes. One medication, nimodipine (Nymalize), has been shown to decrease this problem in people who have had an aneurysmal SAH.
In many cases, doctors will choose to treat your aneurysm with surgery. If an aneurysm is too large to be safely clipped, doctors may drain the blood and monitor your condition for a while before deciding whether or not to perform surgery.
After a subarachnoid hemorrhage, your doctor will likely prescribe medications to prevent complications such as clotting problems and low levels of salts such as sodium in your blood. Some of these medicines increase the width of blood vessels in your brain and others raise your blood pressure to reduce the chances of a stroke from reduced blood flow to the brain.
The outlook (prognosis) for subarachnoid hemorrhage depends on how severe it is, the cause, and any complications or injuries that occur. About one-third of people who have SAH die in the hospital, and about half of those who survive may have impaired brain function. Untreated SAH can lead to a coma or death.
Bleeding usually happens when an irregular bulge or tangle of blood vessels in the brain (aneurysm) bursts. It also can happen from a physical blow to the head or from a chronic condition such as high blood pressure that puts strain on arteries and makes them more likely to leak or rupture. Other causes of SAH include a genetic disorder that weakens the walls of blood vessels (angiogenesis), traumatic brain injury, and arteriovenous malformations.
SAH can be detected with a computed tomography (CT) scan of the brain. Other tests that can be used include magnetic resonance imaging, angiography, and lumbar puncture to test cerebrospinal fluid (CSF). A CT scan can identify complications of SAH, such as communicating hydrocephalus.
If your doctor suspects a subarachnoid hemorrhage, he or she may order a CT scan of the brain right away. Your doctor may also order other tests, such as a lumbar puncture to test CSF or a CAT scan with gadolinium. These scans can help identify the site of a bleed and show other complications, such as if an aneurysm has ruptured or if the bleed is from a traumatic brain injury.
During the first few days after SAH, your doctor will treat any problems such as headache or vomiting. He or she will check your condition often. If your symptoms worsen, you may need to be transferred to a specialized stroke unit. Early intensive care focuses on supporting vital functions, preventing high blood pressure or renewed bleeding, and reducing seizures.
You can reduce your risk of having a SAH by wearing a helmet when participating in high-risk sports, avoiding drinking alcohol or using illegal drugs, practicing healthy eating habits, managing your blood pressure, and getting medical treatment for other health conditions. You should also talk with your healthcare provider about avoiding head trauma and if you have a family history of brain aneurysms, genetic disorders, or other health issues that increase your risk for an aneurysm.
If you have a severe headache that comes on suddenly, call 911 or get to the emergency room right away. Doctors will do a head CT scan to check for bleeding. They may also do a lumbar puncture (spinal tap).
Treatment includes medications and surgery to clip or coil an aneurysm or repair tangled blood vessels (arteriovenous malformations). You can take steps to reduce your risk of future aneurysms:
Everyone gets headaches from time to time, but a severe and sudden headache is a sign or symptom of a life-threatening condition. If you have a thunderclap headache, call for emergency help right away.
Typically, a sudden and severe headache is caused by a brain aneurysm bursting. However, sometimes this type of headache can also occur if an abnormal connection between arteries and veins in the brain (arteriovenous malformation) ruptures.
In 85% of cases, the thunderclap headache is due to a ruptured aneurysm and can be confirmed by MRI imaging in the emergency department. In addition, lumbar puncture (also known as a spinal tap) may be needed to test for blood or fluid in the spinal cord.
Treatment options vary, depending on what’s causing the thunderclap headache. People who have this complication are often treated in a hospital’s intensive care unit. They receive medications to control their blood pressure and seizures, and they’re given a drug called clot-dissolving agents to prevent further bleeds.
Some people have problems such as drowsiness, weakness on one side of the body or trouble using and understanding language after having a subarachnoid hemorrhage (SAH). These problems are related to a condition called vasospasm. The condition is caused by changes in blood flow to the brain. Taking a medicine called nimodipine helps prevent and treat these symptoms.
Hemorrhage occurs when an irregular bulge (aneurysm) in a blood vessel bursts and bleeds into the space between the inner layer of the brain (pia mater) and the middle layer of tissue that covers it (arachnoid mater). Bleeding can cause a severe headache and loss of consciousness. It may also lead to permanent brain damage or death if untreated.
A CT scan or MRI and sometimes a lumbar puncture are done to diagnose SAH. The test is very sensitive and can detect the bleeding quickly. It can also show other problems in the brain and spinal cord, such as a tangle of blood vessels in the brain (arteriovenous malformation). Symptoms of a subarachnoid hemorrhage usually appear suddenly.
If a person has these symptoms, he or she should go to the emergency room right away. It’s important to get help because repeated subarachnoid hemorrhage increases the risk of brain damage and death.
A subarachnoid hemorrhage occurs when blood leaks into the space between the inner layer (pial membrane) and middle layer (arachnoid mater) of the tissues that cover the brain. It usually happens because a bulge or sac (aneurysm) in an artery ruptures. Sometimes the bleeding comes from an abnormal tangle of blood vessels called an arteriovenous malformation or AVM.
A health care team can diagnose a subarachnoid hemorrhage by doing noncontrast head CT scanning. If the scan is negative or equivocal, a lumbar puncture, or spinal tap, can confirm the diagnosis by removing a sample of cerebrospinal fluid for examination. Treatment includes taking medicines to relieve the headache, control blood pressure and prevent a condition called cerebral vasospasm.
If you have these symptoms, get medical care right away. Your doctor may use a noncontrast CT scan of the brain or magnetic resonance imaging (MRI). MRI uses large magnets, radio waves, and a computer to make detailed pictures of your brain without using X-rays. You will probably also have a test called lumbar puncture (spinal tap). This involves injecting a small amount of cerebrospinal fluid from a needle in your lower back to find out whether it contains blood.
After you leave the hospital, follow-up care is important. You may need physical or occupational therapy to help you move and perform tasks more easily, or speech or language therapy to improve your ability to speak and understand others. You may have counseling to help you deal with depression or anxiety that can accompany these problems. Medications can treat the seizures, and a lumbar drain may be used to reduce high pressure in your skull.
Confusion may occur as a result of clotted blood and fluid buildup increasing pressure on your brain enclosed within your skull. This pressure can crush the brain or cause it to shift and herniate. It can also block normal circulation of cerebrospinal fluid (CSF) and enlarge the ventricles (hydrocephalus).
If your healthcare provider suspects you have a subarachnoid hemorrhage based on your symptoms and physical exam, they will do a head CT scan without contrast dye right away. This can detect the bleed and pinpoint its location. They may also do a spinal tap, where a small sample of your cerebrospinal fluid is removed through a needle inserted into your back and then tested to see if it contains blood.
A CT scan and a lumbar puncture can confirm that you have a subarachnoid hematoma and identify complications such as hydrocephalus. They can help your doctor determine the cause of the bleed, such as a ruptured brain aneurysm or an AVM. Treatment focuses on preventing high blood pressure and new bleeding, as well as treating the aneurysm or AVM if it is found.
Hairy Cell Leukemia (HCL) starts in the bone marrow, which is the soft tissue inside your bones where blood cells are made. It happens when a change in your genes causes your bone marrow to make too many white blood cells called B lymphocytes. These abnormal B cells don’t work right and crowd out healthy blood cells that fight infections. As a result, you may have more infections and easier bruising and feel tired. This type of cancer is rare and typically affects older adults. It is more common in men than women.
There are different types of treatments for hairy cell leukemia. These include chemotherapy and other drugs to shrink cancerous cells. Most people with this cancer get a remission, which means the cancer disappears for several years. However, the cancer can come back after treatment. When this happens, you have refractory cancer or resistant cancer. A new drug called moxetumomab pasudotox has been shown to help treat this cancer.
If you have hairy cell leukemia, your doctor will want to check your blood and spleen. They will also look at your medical history and do a physical exam. They will ask questions about your symptoms and when they started.
The first test to diagnose hairy cell leukemia is a complete blood count. This test measures the levels of red blood cells, white blood cells, and platelets in your blood. It will also show whether you have a low platelet count, which can lead to bleeding problems. A peripheral blood smear is another important test for this condition. It is a sample of blood from a finger prick, and doctors can examine it under a microscope to look for the abnormal “hairy” cells that cause this disease.
The brain has a network of blood vessels that receive around one fifth of the blood pumped to it from the heart. Trauma or a weak area in these blood vessels can cause a bleed under the brain’s thin covering (arachnoid layer). This bleed is called a subarachnoid hemorrhage. It can lead to brain damage and a coma if untreated.
Bleeding from an aneurysm in the brain causes a subarachnoid hemorrhage. An aneurysm is a thin bulge in the wall of a blood vessel. Most aneurysms develop over time. But sometimes, they rupture suddenly.
A CT scan usually detects SAH. A lumbar puncture (spinal tap) can confirm the diagnosis. During this test, a small sample of cerebrospinal fluid is removed from the spinal cord through a needle and tested for blood. A special type of X-ray called magnetic resonance angiography also can find the source of bleeding in the brain. Treatment focuses on support of vital functions and preventing high blood pressure, renewed bleeding and seizures.
If a person has these symptoms, they should get medical care as soon as possible. They will need to be rushed into the hospital and given treatment that can prevent complications such as clotting problems and a brain hemorrhage (bleeding).
One of the main ways to diagnose subarachnoid hemorrhage is by doing a CT scan or an MRI. A lumbar puncture, or spinal tap, can confirm the diagnosis by allowing doctors to remove a small sample of cerebrospinal fluid from the spine and check it for blood. Other tests include angiography and MRI angiography, which both evaluate the blood flow patterns in your brain and can spot an aneurysm or AVM.
A subarachnoid hemorrhage can cause long-term problems, such as cognitive (thinking) difficulties, memory problems, and difficulty walking. These problems can lead to depression, anxiety, and posttraumatic stress disorder. People can also have physical issues such as numbness or weakness in part of their body and problems with speech.
If you have a subarachnoid hemorrhage, it’s important to get treatment right away. This will help prevent long-term problems and may prevent brain damage.
You’ll probably have a head CT scan (without contrast dye). A health care provider may also do a lumbar puncture to remove spinal fluid for testing.
The first symptom of subarachnoid hemorrhage is usually a sudden, severe headache called a thunderclap headache. This is a sign that the brain’s blood vessels are leaking and should be treated immediately. Other symptoms include: confusion, memory problems, irritability or changes in mood, weakness in one part of the body, loss of balance or coordination, vision problems such as double vision or blind spots, and neck stiffness.
The condition occurs when a blood vessel ruptures at the base of the brain, filling the space between the brain and the thin tissues that cover it (the subarachnoid cavity). Mount Sinai cerebrovascular specialists are experts in diagnosing this disorder. They may use an eye exam, a computed tomography (CT) brain scan or magnetic resonance imaging (MRI), a lumbar puncture spinal tap (in which a needle is inserted into the lower back to test the fluid that surrounds the spinal cord and the brain, cerebrospinal fluid), or cerebral angiography. The latter helps locate the source of the bleeding and confirms a diagnosis of SAH.
If the cause of SAH is an aneurysm, treatment focuses on stabilizing the patient and treating the aneurysm to prevent a second stroke. The patient is admitted to a hospital that specializes in the treatment of stroke. Bed rest with minimal activity is important. Pain relievers are given, but aspirin and other anti-inflammatory drugs should not be used because they can increase the risk of bleeding. Stool softeners are also given to prevent straining during bowel movements, which can cause more bleeding.
Serious short-term complications of a subarachnoid hemorrhage can include further bleeding at the site of the aneurysm and reduction in blood flow to the brain, causing brain damage. Long-term complications of SAH include physical difficulties such as drowsiness and fatigue, numbness or weakness in parts of the body, trouble swallowing, and difficulty thinking clearly. Psychological issues, such as depression and anxiety, are also common in people who have had SAH. These can be treated with therapy and medications. People who have a second SAH are more likely to die than those who don’t, and one-year mortality rates can be up to 65%.
A subarachnoid hemorrhage (SAH) occurs when blood breaks through the aneurysm sac and leaks into the space between the brain’s arachnoid membrane and pia mater. It is most often caused by a ruptured brain aneurysm. It is a medical emergency and requires immediate treatment. If left untreated, it can lead to a coma or death. The main symptom is severe, sudden, throbbing pain that feels different than your usual headache. This pain is called a thunderclap headache and is one of the most common signs of an SAH. People who experience a thunderclap headache should seek emergency care immediately.
Your healthcare provider will take a history and do a physical exam. They will also order one or more brain imaging tests to look for a subarachnoid hemorrhage. These may include a computed tomography (CT) scan or magnetic resonance imaging (MRI) of your head. CT scans use X-rays to make horizontal images of your brain. MRI uses large magnets, radio waves, and a computer to make detailed images of your brain without using X-rays. Your healthcare provider might do cerebral angiography to get more-detailed images of your blood vessels. During this test, your provider will inject contrast dye into an artery and then take X-rays to see how well the dye flows through your brain’s blood vessels.
If a ruptured aneurysm is the cause of the SAH, your healthcare provider will perform a procedure to treat it. This can involve placing a device through a catheter or doing surgery to open the skull and repair the aneurysm. Your provider might also recommend a procedure to prevent re-bleeding of the aneurysm, such as placing a clip or a stent on the leaking blood vessel.
The long-term complications of SAH can include a persistent headache, drowsiness or fatigue, loss of balance and coordination, memory problems, and difficulty speaking. These problems can interfere with your daily activities. Some people have depression or anxiety after a SAH. Others have difficulty making decisions and find it hard to concentrate. To help reduce your risk for these complications, you should avoid smoking and try to manage any other health conditions that might increase your risk of an aneurysm or SAH. For example, you should control your blood pressure, cholesterol levels, and weight.
If you’ve had a subarachnoid hemorrhage, doctors will try to find out what caused it. They will give you a head CT scan (without dye) right away. A lumbar puncture may be done to test the cerebrospinal fluid. Cerebral angiography can locate the site of the bleeding 85% to 90% of the time in confirmed cases.
In some cases, doctors can’t treat the aneurysm that ruptured. The risk of a new stroke is too high. The doctors might decide to drain the blood from the skull and wait. This is called conservative treatment. You’ll need to stay in bed for a while and avoid strenuous activity. You’ll get pain relievers to control the headaches. Stool softeners are given to prevent straining during bowel movements, which puts pressure on the blood vessels within the skull and increases the risk of a new hemorrhage.
You might need to take anticoagulants or other medicines to prevent blood clots in your brain. Your doctor will give you medicine to treat seizures and low blood pressure (hypotension).
The symptoms of a subarachnoid hemorrhage can be similar to the symptoms of other health problems. It’s important to see your doctor right away.
Long-term complications of SAH include physical problems such as numbness and weakness in parts of your body, trouble swallowing and balance problems. Cognitive (thinking) problems are common, too. They can include memory problems and trouble thinking clearly. Speech difficulties are also common.
The outlook for people who’ve had a subarachnoid haemorrhage depends on their age and how serious the symptoms were. A third of those who die after SAH do so in the hospital. Almost half of the survivors have a good recovery with few or no permanent disabilities. However, people who had a large aneurysm or a second subarachnoid hemorrhage have a worse outlook. SAH can lead to long-term depression, anxiety and problems with learning and memory. It can also lead to problems with relationships. It’s more common in black people than in other races. It can occur at any age, but it’s most common in people between ages 45 and 70.
The first step in treatment is to help control blood pressure and prevent rebleeding. Medicines may be started to prevent cerebral vasospasm, which is a condition in which the blood vessels in the brain go into spasm and restrict blood flow to the brain. You may be given a medicine called nimodipine to reduce the risk of this happening. You are also likely to be given medicines to prevent secondary brain ischaemia, a serious problem in which the supply of oxygenated blood to parts of the brain is reduced.
A CT scan is done right away to identify the extent of the subarachnoid hemorrhage and to look for any complications, such as communicating hydrocephalus. A lumbar puncture is also done to test cerebrospinal fluid (CSF) for the presence of blood.
Once the cause of the subarachnoid hemorrhage has been determined, it must be treated immediately to prevent high blood pressure in the brain and rebleeding. If you have an aneurysm, it must be clipped or otherwise surgically repaired as soon as possible to prevent further bleeds. If you have an AVM, it must be treated according to its specific type.
You will be hospitalized and often transferred to a center that specializes in treating strokes. Bed rest is very important to help prevent blood clots in the brain and rebleeding. You will be given medications to control pain and other symptoms. You will not be given anticoagulants (medicines that thin the blood) or antiplatelet drugs, because they increase your risk of bleeding in the brain.
Many people recover full or nearly full mental and physical function after a subarachnoid hemorrhage, especially if it is treated quickly. However, some people die in the hospital, usually from head trauma or other related causes. People with severe symptoms, such as weakness on one side of the body or loss of consciousness, are at a greater risk for poor outcome.
You can help lower your chance of having a subarachnoid hemorrhage by wearing a helmet when participating in high-risk sports, following health care advice for controlling blood pressure, and not smoking.
