Subarachnoid hemorrhage (SAH) implies the presence of blood within the subarachnoid space from some pathologic process. Subarachnoid hemorrhage occurs when a blood vessel just outside the brain ruptures. It may arise due to trauma or spontaneously, and is a medical emergency which can lead to death or severe disability even if recognized and treated in an early stage. Subarachnoid hemorrhage is most often caused by abnormalities of the arteries at the base of the brain, called cerebral aneurysms. Subarachnoid hemorrhage due to rupture of a cerebral aneurysm occurs in approximately 10-15 out of 10,000 people. Subarachnoid hemorrhage due to rupture of a cerebral aneurysm is most common in persons age 20 to 60. It is slightly more common in women than men.

A further 10% of cases is due to non-aneurysmal perimesencephalic hemorrhage, in which the blood is limited to the area of the midbrain. Risk factors for subarachnoid hemorrhage are smoking, hypertension and extreme alcohol intake; all are associated with a doubled risk for SAH. The goals of treatment are to save your life, repair the cause of bleeding, relieve symptoms, and prevent complications. Pain killers and anti-anxiety medications may be used to relieve headache and reduce intracranial pressure. Phenytoin or other medications may be used to prevent or treat seizures. Analgesia (pain control) is generally restricted to non-sedating agents, as sedation would interfere with the monitoring of the level of consciousness.

Surgery may involve a craniotomy and aneurysm clipping, which closes the aneurysm, or endovascular coiling, a procedure in which coils are placed within the aneurysm to prevent further bleeding. Nimodipine, an oral calcium channel blocker, has been shown to reduce the chance of a bad outcome. Nutrition is an early priority, with oral or nasogastric tube feeding being preferable over parenteral routes. Do not smoke, avoid caffeinated beverages, and have your blood pressure checked regularly. Stool softeners are given to prevent constipation, which can lead to straining. Anticoagulants and antiplatelet drugs are contraindicated. If you have a family history of strokes and aneurysms and monitor your blood pressure. If an aneurysm is discovered early, the doctor may be able to repair the weak spot.

Subarachnoid Hemorrhage Treatment and Prevention Tips

1. Anticoagulants and antiplatelet drugs are contraindicated.

2. Use rapid sequence intubation if possible.

3. Avoid excessive or inadequate hyperventilation.

4. Avoid excessive sedation.

5. Use medications that can be titrated rapidly.

6. Thiopental and etomidate are the optimal induction agents in SAH during an intubation.