Subarachnoid haemorrhage is an acute intracranial hemorrhage into the subarachnoid space, which is located between the arachnoid (spiderweb skin) and the pia mater (vascular part of the meninges), which together form the soft meninges (leptomeninx).
Symptoms characteristic of subarachnoid haemorrhage are sudden, very severe headache in the back of the head (nausea headache), nausea and vomiting, meningism (neck stiffness, photosensitivity), and initial clouding of consciousness.
In the later course, as a result of increasing intracranial pressure, unconsciousness, coma as well as circulatory and respiratory arrest are characteristic of subarachnoid haemorrhage.
Subarachnoid haemorrhage is most often due to rupture of a cerebral artery aneurysm. A cerebral aneurysm is usually caused by a genetic vascular wall weakness in the area of the brain base, as a result of which evagination of the vessels (aneurysms) develop, which can burst (rupture) and lead to a subarachnoid hemorrhage.
Aneurysm rupture is favored by physical exertion such as the lifting of heavy objects or sexual intercourse.
In addition, in rare cases traumatic brain injury, sinus vein thrombosis (occlusion of the large blood vessels of the brain), angiomas (vascular malformations), coagulation disorders and vascular inflammation may cause a subarachnoid hemorrhage.
Hypertension (high blood pressure), nicotine consumption in hypercholesterolemia (elevated blood cholesterol) and drug use (heroin, amphetamines) are factors that promote the manifestation of an aneurysm and thus a subarachnoid hemorrhage.
The first symptom of subarachnoid haemorrhage is usually sudden and extremely severe headache, referred to as exterminating headache. Patients describe it as unbearable and never experienced it in a similar way before. The pain usually starts from the forehead or the neck and spreads over the whole head, sometimes even to the back. However, this symptom may also be absent.
In addition, sufferers from a stiff neck, nausea, vomiting and increased photosensitivity. The blood pressure can increase or decrease, the respiratory rate changes and the body temperature fluctuates frequently. The pulse can beat irregularly and paralysis can occur.
Rarely epileptic seizures occur. The symptoms are divided into five grades, after which the severity of the bleeding can be assessed. At Grade I, only mild headache occurs. Grade II shows more headache and the neck is stiff. When grade III is reached, drowsiness and mild neurological disorders such as paralysis or impaired sensitivity occur.
Grade IV of a subarachnoid hemorrhage is manifested in a coma-like sleep. In addition, respiratory disorders and hemiplegia occur. At Grade V, there is a heavy bleeding and the patient falls into a coma. The pupils no longer respond to light stimuli and there are pronounced neurological disorders.
A subarachnoid haemorrhage is diagnosed on the basis of the characteristic symptoms, whereby the specific symptoms present provide information about the stage of the disease. For example, mild headaches and neck stiffness are associated with an early stage (Grade I).
These increase in the further course and can be accompanied by cranial nerve failures (grade II). Additional consciousness opacities and neurological focal symptoms indicate Grade III disease. Subsequently, symptoms such as somnolence or sopor (deep sleep), hemiparesis (hemiplegia), circulatory and respiratory disorders (grade IV) as well as coma, stretching cramps and impaired vital functions (grade V) may manifest.
The diagnosis is confirmed by imaging techniques such as computed tomography (first week after a subarachnoid hemorrhage), magnetic resonance imaging or lumbar puncture (from the 8th day). Doppler sonography is used to rule out possible vasospasm (vascular spasm), while angiography provides information about the exact location of the aneurysm.
The prognosis is unfavorable for a subarachnoid hemorrhage. About half of those affected die within the first 30 days of subarachnoid hemorrhage. In addition, there is an increased risk of brain function impairment despite successful surgery.
In the worst case, the subarachnoid hemorrhage can lead to the death of the person affected. However, this only occurs if the disease is not treated. The sufferers suffer primarily from very severe headaches. These can also spread to the neighboring regions of the body and cause pain there as well.
Furthermore, it comes to those affected vomit and also to a nausea. These complaints also have a very negative impact on the patient's quality of life. Also, a high sensitivity to light and noise may occur in the subarachnoid hemorrhage and complicate the everyday life of the person concerned.
Many patients also suffer from a very stiff neck and possibly pain in this area. Subarachnoid hemorrhage may result in unconsciousness in which the person may be injured in a fall. The treatment of bleeding is usually done by surgery.
There are no special complications and the symptoms can be alleviated. However, due to the bleeding, the risk of a stroke increases significantly, so the person continues to be dependent on various therapies and examinations. This may also reduce the life expectancy of the patient.
This condition should always be followed by a doctor. The sooner the subarachnoid haemorrhage is detected and treated, the better in most cases is the progression of the disease. Only early diagnosis with subsequent treatment can prevent further complications or discomfort. If the subarachnoid hemorrhage remains untreated, it can in the worst case, the death of the person affected. A doctor should be consulted if the person suffering from very severe headache. In most cases, the person concerned can no longer concentrate and no longer pursue his or her everyday life.
Even a stiff neck and severe nausea associated with vomiting may indicate a subarachnoid hemorrhage. Some sufferers are very sensitive to light or even have an epileptic seizure. If it comes to such a seizure, immediately go to a hospital or call an ambulance. As a rule, the subarachnoid hemorrhage can be detected by a general practitioner. In the further treatment, however, a specialist and usually also a surgical intervention is necessary. No general prognosis can be made about the further course and the life expectancy of the patient.
The therapeutic measures aimed at subarachnoid hemorrhage on the stabilization of the general condition of the person affected by an intensive medical care. In case of an aneurysm rupture, the vascular bag is separated from the blood circulation and the subarachnoid haemorrhage is stopped in the course of a surgical procedure.
For this purpose, two surgical procedures are used. In the so-called clipping procedure, the aneurysm is isolated from the circulatory system by means of special clips on the vessel outlet in order to exclude further intracranial hemorrhages. In addition to this procedure, which is performed directly on the brain, a microspiral made of platinum (platinum coil) is introduced into the aneurysm in the meanwhile more frequently used coiling procedure with the help of a catheter leading through the inguinal artery.
After the platinum coil has been placed, the coil winds up and as a result of subsequent thrombosis, the mesh of the coil and thus the aneurysm are closed. Due to the increased risk of vascular occlusion, appropriate thrombosis prophylaxis should be used postoperatively. If there are already vasospasms (vascular spasms) or if the affected person is in bad condition, because of the increased risk of stroke, it is generally treated conservatively until the spasms fade (at least 10-12 days) and attempts to maintain the blood circulation as far as possible,
Calcium antagonists such as nimodipine and infusions for dilution of the blood with simultaneous increase in blood volume (hypervolemic hemodilution) are preferably used for this purpose. Intubation and ventilation may be required. If subarachnoid hemorrhage is due to angioma, it is often embolized to prevent recurrent bleeding. In addition, both conservative and operative therapy requires absolute bed rest to minimize the risk of rebleeding.
Subarachnoid hemorrhage can only be prevented to a limited extent. Measures to combat high blood pressure, abstention from nicotine and excessive alcohol consumption and the avoidance of obesity through a healthy diet and regular exercise prevent aneurysm and thus indirectly subarachnoid hemorrhage.
Patients with subarachnoid haemorrhage usually have only a few and only limited measures of follow-up care available. For this reason, the patient should see a doctor at the first symptoms and signs of the disease, so that further complications can be prevented. As a rule, no self-healing can occur, so that the person is dependent on a medical examination and treatment.
The sooner a doctor is visited, the better is usually the further course of the disease. Most sufferers are dependent on surgery, which usually also the measures of radiotherapy or chemotherapy are necessary. Even after removal, regular checks by a doctor are very important in order to detect and treat other tumors at an early stage.
Patients should generally rest and care for this disease, although in severe cases, strict bed rest is also required. As a rule, this disease does not reduce the life expectancy of the patient, and a general course can not be predicted.
The everyday life of those affected is in most cases characterized by heteronomy. The damage is almost always associated with permanent disturbances. Everyday life should be adapted to the severity and complexity of the impairments, with self-help always in the foreground.
Relatives and caregivers can support those affected in everyday life by working according to the Bobath concept. The regulation of muscle tone, the initiation of normal movements and the promotion of body awareness are the three basic aspects. This results in an everyday life in which food intake, mobility, excretion, dressing and washing is supported. However, it is always necessary to release spastic paralysis by movement and to avoid negative stimuli such as cold hands. Physiological movements can be supported in particular in daily activities such as brushing, combing or eating, whereby the bilateral arm guidance must always be focused.
People with subarachnoid haemorrhage often suffer from reduced attention. Therefore, the living situation must be redesigned accordingly and distractions eliminated. Because only a few stimuli, the brain can adapt over time.
Anosognosia, neglect or pusher syndrome greatly increase the risk of falling. The avoidance of falls during storage or mobilization must therefore always be considered, as these have a further immobility and dependence result.