Have you ever had a sudden, excruciating headache that felt like your head was exploding, or like lightning had struck you? Some people call it "the worst headache of your life." This is no joke. This can be a very dangerous condition. In medicine, we call this condition `(Subarachnoid Hemorrhage)` or `(SAH)` . This is truly a medical emergency. So let's talk about this in a little more detail, in simple terms, okay?
What exactly is this (Subarachnoid Hemorrhage)? Let's understand it simply, shall we?
Simply put, `(Subarachnoid Hemorrhage)` is when there is bleeding in the space between our brain and the thin covering membrane that surrounds the brain . Think of it, our brain is like a precious jewel. So to protect it, nature has given us three layers of thin covering membrane. We call these `(Meninges)`. It's like the skin of an onion, or the several layers like the husk of a coconut.
These three coverings are:
- Dura mater: This is the slightly stronger outer covering just beneath the skull.
- Arachnoid mater: This is the middle covering. A delicate membrane that resembles a spider's web.
- Pia mater: This is the very thin, innermost covering that is attached to the brain itself.
Now, what happens in this `(Subarachnoid Hemorrhage)` is that bleeding occurs under the arachnoid membrane in the middle (that is, in the "sub-arachnoid" space). This is very dangerous, because this bleeding can put pressure on the brain, and brain cells can be damaged. That is why this is considered a medical emergency.
What is the difference between (Subarachnoid Hemorrhage) and (Subdural Hematoma)?
You may have heard of another condition called ``Subdural Hematoma''. Both are bleeding inside the brain. The difference is where the bleeding occurs .
- In a ``Subdural Hematoma'', blood flows into the space beneath the outermost covering, the ``dura mater'' that we mentioned earlier.
- In a subarachnoid hemorrhage, blood flows into the space beneath the arachnoid membrane .
The symptoms of both can sometimes be similar, both can cause brain damage, and both are conditions that require emergency medical treatment.
Who is more likely to develop SAH? What are the risk factors?
This condition, called ``Subarachnoid Hemorrhage,'' can occur in anyone. However, it is more common in people between the ages of 40 and 60 .
Head trauma (SAH) is more common in older adults because of the increased risk of falls and loss of balance as people age. Among younger people, motor vehicle accidents are the leading cause.
In addition, there are several other risk factors that can contribute to the development of SAH. They are:
- Having an unruptured aneurysm in your brain or elsewhere in your body (an aneurysm is a blood vessel that bulges like a balloon).
- Having a history of a previous ruptured brain aneurysm.
- Smoking tobacco. (This is the cause of many diseases, isn't it?)
- Having high blood pressure (Hypertension). (We say "high pressure").
- Some genetic conditions, for example, connective tissue diseases such as ``Fibromuscular dysplasia (FMD)`` and ``Ehlers-Danlos syndrome``.
- Having a kidney disease called ``(Polycystic kidney disease)''.
- Use of drugs such as cocaine and/or methamphetamine.
- Excessive alcohol consumption.
- Use of blood thinners such as Warfarin (These should only be used under the advice of a doctor).
- If someone in your family has had an aneurysm (that means a strong family history).
Important: If you have one or more of these risk factors, it does not mean that you will definitely develop SAH. However, it does mean that your risk is higher. Therefore, it is very important to seek medical advice.
What are the symptoms of this dangerous condition? How do you recognize it?
The main and most dangerous symptom of a subarachnoid hemorrhage is the "thunderclap headache" we mentioned earlier. This is a very severe, sudden headache. It can feel like something is exploding inside your head. Many people say, "I've never had a headache like this in my life."
If you experience a severe, sudden headache like this, especially if you have any of the other symptoms listed below, please call 911 (1990 Suwaseriya in Sri Lanka) without delay, or go to the nearest emergency room as soon as possible. This could save your life!
Other symptoms are:
- Decreased consciousness and difficulty staying awake.
- Nausea and vomiting.
- Feeling of stiffness in the neck, difficulty bending the neck (Stiff neck) .
- Feeling like you're suddenly losing your life.
- Mood and personality changes (e.g., agitation, irritability).
- Dizziness .
- Photophobia (eye sensitivity to bright light) .
- Muscle pain , especially in the neck and shoulders.
- Numbness of a part of the body.
- Having a fit (seizure) `(Seizures)` .
- Vision changes : Double vision, black spots in vision, temporary loss of vision in one eye.
If one or more of these symptoms are accompanied by that severe headache, there is a high chance that it is a 'SAH'.
Why does this (Subarachnoid Hemorrhage) occur? What are the main causes?
There are two main reasons why a subarachnoid hemorrhage occurs.
1. Head trauma: This is the most common cause. For example, a severe fall or a car accident can cause a severe blow to the head.
2. Ruptured brain aneurysm: This is also a very common cause. As we mentioned earlier, an aneurysm is a weak spot in the wall of a blood vessel in the brain that bulges like a balloon. If it suddenly bursts, blood flows directly into the space under the arachnoid membrane. This is the cause of 85% of sudden aneurysm ruptures (SAH) without a head injury.
In addition to these two main reasons, there are several other less common reasons:
- Bleeding from a tangled area of blood vessels. This is called an ``Arteriovenous malformation (AVM)``.
- Some bleeding disorders.
- Use of blood thinners (when used without medical advice).
- Use of drugs such as cocaine and/or methamphetamine.
How do doctors diagnose this? What tests do they do?
If, after reviewing your symptoms and an initial examination, a doctor suspects that you have a ``Subarachnoid Hemorrhage'', he will immediately order a ``CT scan'' (Computerized Tomography scan).
A CT scan can take detailed pictures of the tissues in our body. A CT scan of the brain is a very effective way to see if there is SAH. Sometimes, a CT angiography (CTA) scan, which involves injecting a special fluid into a vein, can also look at the condition of the blood vessels.
However, if it is a very small SAH, or if it happened less than two weeks ago, it may not be detected by a CT scan. In that case, the doctor may need to do a few more tests.
They are:
- Lumbar puncture: This involves inserting a very thin needle into your lower back and taking a sample of the fluid that surrounds your brain and spinal cord (called cerebrospinal fluid - CSF). This fluid is then tested for xanthochromia (a yellowish appearance). If it is present, it could mean that you have SAH.
- Brain magnetic resonance imaging (MRI): This can also check for recent brain bleeding.
Once a SAH is diagnosed, treatment in the hospital begins with finding and treating the cause, as well as managing any complications that may arise. Because more than 80% of SAHs without a head injury are caused by an aneurysm, doctors often perform a test called a cerebral angiogram, which takes pictures of the arteries in the brain, and treats the aneurysm.
What are the treatments for this? How long will it take to recover?
Subarachnoid hemorrhage is a life-threatening emergency and is usually treated in a hospital's intensive care unit (ICU) , where there is expertise in neurological diseases. The main goals of treatment are to:
- Saving your life.
- Identify the cause of the bleeding and treat it.
- Relieving symptoms.
- Preventing complications (e.g. Vasospasm - constriction of blood vessels, Hydrocephalus - accumulation of fluid in the brain, permanent brain damage).
Life-saving treatments and symptom control treatments may include:
- Life support systems.
- Inserting a tube to relieve pressure in the brain.
- Methods of protecting the respiratory tract.
- Medicine to reduce swelling inside the skull.
- Medication given intravenously to control blood pressure.
- Medicines to prevent vasospasms.
- Painkillers for headaches and anti-anxiety medications.
- Medication to prevent or treat the fit.
You may also need surgery to treat SAH and its cause:
- If SAH is caused by an injury, remove any large blood clots that have accumulated, or reduce pressure on the brain.
- If an aneurysm has ruptured and become a ``SAH'', repair the aneurysm.
The length of time you stay in the hospital will vary depending on your health condition. Most people with SAH will stay in the hospital for 10 to 20 days , depending on their condition and whether they need rehabilitation.
What can we do to prevent SAH from developing?
Most cases of subarachnoid hemorrhage are caused by head injuries and/or ruptured brain aneurysms. Therefore, the best thing we can do to avoid having a subarachnoid hemorrhage is to try to control the risk factors for both of these conditions.
Take care not to injure your head:
- Always wear a helmet when riding a bicycle, motorcycle, or playing high-risk sports.
- Always drive safely and obey traffic laws.
- If you fall frequently, see a physical therapist or occupational therapist to learn ways to prevent falls, and to make your home environment safer.
To reduce the risk of developing a brain aneurysm and/or prevent an existing aneurysm from bursting:
- Talk to your doctor about what you can do to stay healthy. He or she will often recommend the following:
- Control high blood pressure (with medication and lifestyle changes).
- Avoid smoking.
- Exercise regularly (but avoid lifting heavy weights all at once, as this can cause an aneurysm to burst).
- Eat a balanced diet.
- If you have problems with alcohol or drug use, get help. Don't use stimulants like cocaine.
What can be expected after this condition? (Prognosis and Complications)
The prognosis after a subarachnoid hemorrhage depends on the cause, how severe it is, and whether there are other complications or injuries.
This is a very serious condition . About half of people who develop SAH die suddenly . Of those who are able to get to a hospital:
- About a third die in the hospital.
- About one-third live with some kind of disability.
- About one-third return to normal.
The immediate complications of SAH are:
- Having a fit (Seizures).
- Vasospasm (narrowing of a blood vessel in the brain, blocking blood flow).
- Bleeding again after initial treatment.
- Hydrocephalus (accumulation of fluid in the brain).
- Increased intracranial pressure.
- Brain herniation.
- Cerebral infarction / ischemic stroke is caused by a decrease in blood supply to the brain.
- Death.
What are the long-term complications of SAH?
Because a subarachnoid hemorrhage can damage the brain, it can cause long-term, even permanent, problems. Possible long-term complications include:
- Physical problems: Frequent drowsiness and fatigue, numbness or weakness in body parts, difficulty swallowing, loss of balance.
- Cognitive issues: memory problems, difficulty concentrating, difficulty planning and performing complex tasks.
- Speech difficulties: Slurred speech or slow speech. Difficulty finding the words you need.
- Mental health issues: SAH is a major life trauma. It can lead to conditions such as depression, generalized anxiety, and post-traumatic stress disorder (PTSD).
There are various treatments for these long-term complications. For example:
- Physical therapy.
- Occupational therapy.
- Speech therapy.
- Psychotherapy (talk therapy).
Some medications can also help with this. If you have any of these problems, talk to your medical team.
If left untreated, SAH has a 65% chance of dying within a year. However, if properly diagnosed and treated, the chance of dying within a year can be reduced to about 18%.
If you have been diagnosed with SAH, you will need to see your medical team regularly to monitor your health and progress. You may also need physical, occupational, and/or speech therapy if complications develop.
Take-Home Message
Okay, so I hope you now have a good understanding of what we talked about today, `(Subarachnoid Hemorrhage).` Here are some of the most important things to remember:
- A sudden, severe, thunderclap headache can be a key symptom of SAH.
- `(SAH)` is a medical emergency . If you have symptoms, seek medical help without delay.
- Head injuries and ruptured brain aneurysms are the main causes of this.
- The risk of developing SAH can be reduced by controlling risk factors and adopting a safe lifestyle.
- Although this condition is serious, there is an opportunity to save lives and live a good life through prompt treatment and proper rehabilitation.
So, be aware of this too. If you or someone you know develops any of these symptoms, take action immediately. Stay healthy!
` Subarachnoid Hemorrhage, SAH, Brain bleeding, Thunderclap headache, Brain aneurysm, Emergency treatment, Head injury, Brain covering
💬 අදහස් (0)
තවමත් කිසිදු අදහසක් පළ කර නොමැත. ඔබේ අදහස පළමු වරට මෙහි එක් කරන්න.
ඔබේ අදහස එක් කරන්න