Subarachnoid Hemorrhage: Causes and Treatments

Subarachnoid Hemorrhage: Causes and Treatments

Subarachnoid Hemorrhage: Causes and Treatments

Apr 21, 2023

Subarachnoid Hemorrhage Causes and Treatments

You would probably have a basic idea of what hemorrhage is and vaguely know it is related to
bleeding. Yes, hemorrhage is bleeding a blood vessel, causing blood loss internally or externally.
Though a brain hemorrhage is a common medical condition, a subarachnoid hemorrhage is a rare
condition that occurs in fewer people. Hemorrhages are more noticeable in natural openings like
the nose, mouth, rectum, etc. On the other hand, subarachnoid hemorrhage is a type of internal
bleeding with brain bleeding symptoms that may be difficult to notice in the early stages. In this
article, let’s look at Subarachnoid hemorrhage and its causes and symptoms.

What Is A Subarachnoid Hemorrhage?

Subarachnoid hemorrhage (SAH) is a medical condition that concerns bleeding in the
subarachnoid space. Subarachnoid space in the middle region between a brain and the
surrounding membrane. Patients with subarachnoid hemorrhage will primarily suffer from a
sudden, severe headache. This headache will be worse than any regular headache with sharp
Subarachnoid hemorrhage is a medical emergency that must be treated immediately as soon as
one suffers from symptoms of permanent brain damage or death. Internal bleeding is due to a
blood vessel bursting in the brain aneurysm. Along with the primary symptom of a sudden,
severe headache, one may also experience subarachnoid hemorrhage symptoms such as:

  • Loss of consciousness

  • Nausea and feeling weak

  • Vomiting and dizziness

  • Stiff neck or back pain

  • Problems with vision and blurriness

Though the bleeding leading to subarachnoid hemorrhage may occur due to a bulge or rupture in
a blood vessel(cerebral aneurysm), it may also be caused by a tangle of blood vessels in the brain
(arteriovenous malformation).

What Causes Subarachnoid Hemorrhage?

Though it is unknown how exactly brain aneurysms develop in some people, cerebral
hemorrhage can occur due to a ruptured aneurysm, AVM, or head injury. Some other
subarachnoid hemorrhage causes include:

  • Smoking cigarettes or use of other drugs

  • High blood pressure

  • excessive consumption of alcohol

  • a family relation with the same condition

  • severe head injury

  • Some types of connective tissue diseases

  • Prior brain aneurysm

Most brain aneurysms won’t rupture, but a procedure to prevent subarachnoid hemorrhage is
sometimes recommended if detected early.
Which Color of Cerebrospinal Fluid (CSF) Indicates Subarachnoid Hemorrhage?
The color of cerebrospinal fluid (CSF) that indicates a subarachnoid hemorrhage is yellow. A
colorless CSF is an indicator of a normal condition. The yellow color of CSF is generally due to
the breakdown (hemolysis) of the red blood cells (RBC). A yellow pigment known as bilirubin is
produced during the hemolysis process. Other causes include subarachnoid hemorrhage,
increased CSF protein, hemoglobinemia, jaundice, or hypercarotenemia. Translucent CSF
indicates an increased white blood cell count, indicating a possible infection. If the CSF is
brown, it shows the presence of methemoglobin from a previous meningeal hemorrhage.

Diagnosis and Subarachnoid Hemorrhage Treatment

A subarachnoid hemorrhage (SAH) can be diagnosed through the following primary tests:

  • Computerized tomography (CT scan): The CT scan gives a visual view of the brain and checks
    for a subarachnoid hemorrhage depicted by a variation. If a CT scan is not practical for detecting
    a small subarachnoid hemorrhage, other tests are advised, like CT angiography (CTA). CTA
    visualizes the blood vessels using contrast material injected through a vein.

  • Lumbar puncture: The CSF flows in the spinal cord and brain connection. The CSF fluid is
    obtained by placing a small needle in the lower back in this process. Any variation in the color of
    the fluid indicates subarachnoid hemorrhage.

  • Magnetic resonance imaging (MRI): MRI is a brain imaging test to understand if there has been
    bleeding in the brain recently within a few weeks.

Analyzing Brain Aneurysm

Endovascular treatment of an aneurysm is usually a minimally invasive procedure involving
cerebral angiography first to access the aneurysm. The doctor will suggest the type of treatment
by considering the characteristics of the aneurysm, medical history, and the patient’s health. In
some cases, open surgery or endovascular treatment is advised for treating brain aneurysms in

Open Surgical Techniques

  • Clipping

Microsurgical clipping is a surgical technique that helps secure brain aneurysms. A craniotomy is
a procedure that involves creating an incision on the head and removing a small part of the skull

that will be placed back after the procedure. Microsurgical clipping consists of a craniotomy to
treat the hemorrhage further.
The brain remains exposed till the surgical team gets access to the aneurysm by dissecting the
brain. An intraoperative microscope is used for the dissection. Once the aneurysm is seeable, a
small clip is placed around the underside of the aneurysm. The skull portion is restored with
plates and screws, and the incision is stitched back.

  • Vessel Bypass

Vessel bypass is done in cases where the aneurysm is situated in a region that won’t allow short
microsurgical clipping. After the craniotomy and the aneurysm is secured, another blood vessel
may be directed to the artery to ensure enough blood flow to the brain. Blood vessels may be
taken from the brain or the arms or legs. MRI-safe Titanium or titanium alloys are used for open

Endovascular Surgical Techniques

The two types of endovascular treatments are:

  • Coiling

Coiling is a catheter-based process in which a cerebral angiogram is performed after inserting a
catheter into the brain. The catheter is extended to the aneurysm base, and platinum coils are
released into it. The coils tuck themselves to fill the aneurysm and develop a clot to control the
bleeding into the aneurysm. The stent will support the coils placed in the aneurysm, and regular
blood flow is restored through the artery.

  • Stenting/Flow Diversion:

Stenting is an advanced process where a flow diversion device is used. Stents or tubes are placed
across the aneurysm base to reduce the blood flow, which causes clot formation and eventually
cures the bleeding. A patient is prescribed extra medicines to control further clots from
developing within the stenting.

Subarachnoid Hemorrhage: Getting Treatments at The Right Time

Any medical condition should be treated earlier by receiving proper treatments. Medications and
subarachnoid hemorrhage treatment duration may vary with each patient’s condition. However
ordinary the symptoms may seem, you must check yourself as soon as possible.