Subarachnoid hemorrhage

Legend By Legend, 1st Nov 2013 | Follow this author | RSS Feed
Posted in Wikinut>Health>General Health>Headaches & Migraines

Subarachnoid hemorrhage is a rare but potentially serious reason for sudden headaches and should be considered in any headache classified as a "thunderclap" headache.

Subarchnoid hemorrhage - anataomy

The cortex of the brain is covered by a thin membrane known as the "pia mater". The pia mater is covered by a highly vascular membrane knwon as the arachnoid membrane. Rupture of the blood vessels of the archnoid can create a bleeding which accumulates between the pia mater and the arachnoid membrane - hence it is called a "sub" arachnoid hemorrhage. These bleedings can occur following trauma or spontaneously in which case they are often associated with vascular anomalies that create a tendency to rupture and bleed.

Subarachnoid hemorrhage - presentation

Classically, the presentation of a spontaneous subarachnoid hemorrhage is that of a "thunderclap" headache - a headache of extreme intensity. Occasionally, the hemorrhage is associated with neurological signs. These can be focal signs derived from the location of the hemorrhage or signs of inflammation of the membranes surounding the brain, the meninges - signs similar to those seen in meningitis. Other symptoms that can develop are involvement of the eye, signs of increased intracerebral pressure and on rare occasions a "sympathetic surge" can be seen. This surge can result in extreme shifts in blood pressure, pulmonary edema, tachycardia and even severe cardiac events.

Subarachnoid hemorrhage - diagnosis

In most cases, a subarachnoid hemorrhage can be readily diagnosed by computed tomography where an area of bleeding can be easily demonstrated. With elevated clinical suspicion and a normal scan, it is appropraite to consider a computed tomography scan with radio contrast which has a greater sensitivity and specificity. Even in the face of a normal radiocontrast scan, if the clinical presentation is sufficiently convincing, the next test should be a lumbar puncture. In the lumbar puncture, signs of frank blood and yellow traces of bilirubin from previous bleeding can be seen in up to 3% of normal CT scans.

Subarachnoid hemorrhage - treatment

Treatment for subarachnoid is very dependent on clinical presentation and findings per computed tomography scan. If aneurysms are identified, these can be treated using a variety of methods such as clipping or coils, to prevent rebleeding. If a large pool of blood accumulates in an accessible place and the patient is symptomatic, neurosurgical decompression becomes an option. If no clear bleeding site has been identified a cautious course of hospitalization for observation can be considered.


Aneursym, Headache, Hemorrhage, Sah, Subarachnoid, Thunderclap, Tomography

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author avatar Legend
I am a practicing physician. I have spent 5 years in Yeshiva studying religion. I published a card game on wikinut and I am in a process of getting divorced

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