Overview
Diagnosis
To diagnose a subarachnoid hemorrhage, several tests may be used to confirm bleeding around the brain and identify its cause. A CT scan is often the first test because it can quickly detect bleeding. In some cases, contrast dye is added to create a CT angiogram for a more detailed view of blood vessels. An MRI also can detect bleeding, and an MR angiogram may be used to study arteries and veins more closely. Cerebral angiography provides highly detailed images by guiding a catheter into a blood vessel and injecting dye to highlight the brain’s arteries. If early imaging doesn’t show bleeding but a subarachnoid hemorrhage is still suspected, a lumbar puncture may be done to check for blood in the cerebrospinal fluid.
Treatment
Treatment focuses on stabilizing the condition and preventing further bleeding or complications. Your healthcare team monitors vital functions such as breathing, blood pressure and blood flow. When a burst aneurysm causes the hemorrhage, treating the aneurysm quickly is essential. Treatment options include surgery, in which a metal clip is placed on the aneurysm to stop blood flow, and endovascular embolization, where coils are inserted to promote clotting inside the aneurysm. Newer endovascular techniques such as stent-assisted or balloon-assisted coiling may also be used.
Managing complications is an important part of care. A subarachnoid hemorrhage can lead to changes in sodium or blood sugar levels, which require monitoring. Vasospasm, a narrowing of brain blood vessels, is a common complication that can lead to stroke if blood flow drops too much. Medicines such as nimodipine and treatments to raise blood pressure or widen vessels can help lower this risk. Another possible complication is hydrocephalus, a buildup of fluid in the brain’s cavities, which can be treated using drains. Follow-up care and therapies such as physical, occupational and speech rehabilitation may be needed, and some procedures may need to be repeated depending on recovery and long-term progress.
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