A sub arachnoid haemorrhage (SAH) is a type of stroke caused by bleed in the brain which is due to a ruptured aneurysm. This condition affects about 9000 of people each year. It is obviously a serious condition that can be fatal or can lead to severe disabilities. Some fortunate patients do survive a SAH with no or minimal after effects.
The classic sign of a subarachnoid haemorrhage is a sudden onset severe headache. It is often describes as like being hit on the head with a hammer. Patients and doctors often describe it as a “thunderclap” headache. Other classic symptoms can be a stiff neck and sensitivity to light.
The cause is usually a weakness in the wall of one of the blood vessels supplying blood to the brain which causes a swelling. The build-up of blood pressure in this location causes the swelling to expand and then burst. The location of the weak spot is known as an aneurysm. The aneurysm can often burst when a person with this condition undertakes strenuous activity.
The diagnosis is confirmed by a CT scan. The scan can identify the aneurysm in 95% of cases and therefore rule out any other cause for the symptoms.
If the CT scan does not show an aneurysm then often a lumbar puncture is performed. This is a procedure to take a sample of cerebrospinal fluid (CSF) for the spine for analysis.
Once the diagnosis has been made neurosurgeons will take over care of the patient (if not involved already). They will be assisted by neuroradiologists. They will arrange for the patient to undergo an angiogram to precisely work out how to treat the aneurysm.
The normal treatment for this condition is now endovascular coiling. This is performed by a neuroradiologist using minimally invasive techniques. In the recent past a procedure known as ‘clipping’ was performed, usually by a neurosurgeon. This is a more invasive technique.
Both techniques have very high success rates.
Types of cases
Problems with treatment are usually due a failure to suspect this condition and refer quickly for diagnosis/coiling.
The severe sudden onset headache can often be dismissed as a migraine, a stress headache or the classic stiff neck blamed upon a posture problem.
The diagnosis can often be missed as the condition is quite rare. A GP would expect to see only one or two such cases in their entire career. Delays in diagnosis can lead to a severe brain injury or sadly even death.
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