Medicines for Subarachnoid haemorrhage

What it is

A subarachnoid haemorrhage is a type of bleeding (haemorrhage) that occurs in the space between the brain and the thin membranes that cover it (the subarachnoid space). It is an uncommon but very serious, life-threatening type of stroke, and is a medical emergency that needs immediate treatment. It is most often caused by the bursting (rupture) of a weakened, bulging area of a blood vessel (a brain aneurysm), and can also result from a head injury or other causes. The most characteristic symptom is a sudden, severe headache — often described as the worst headache ever experienced, coming on very abruptly (a "thunderclap" headache) and reaching maximum intensity within seconds to a minute, sometimes described like being hit on the back of the head. Other symptoms can include: a stiff neck; sensitivity to light; feeling or being sick (vomiting); brief loss of consciousness or collapse; confusion or reduced consciousness; seizures (fits); weakness or other stroke-like symptoms; and sometimes a warning "sentinel" headache in the days or weeks before. Because a subarachnoid haemorrhage is life-threatening and needs urgent treatment, a sudden, severe, unusual headache — particularly one that comes on abruptly and is the worst ever, or is associated with a stiff neck, vomiting, loss of consciousness, or other neurological symptoms — is a medical emergency: emergency services should be called immediately. Diagnosis is made urgently in hospital, usually with a brain scan (CT) and sometimes a lumbar puncture, and treatment involves urgent specialist care to stop or prevent further bleeding (for example treating the aneurysm), manage complications, and support the person. A subarachnoid haemorrhage is serious and can be fatal or cause lasting effects, and prompt treatment improves the chances of recovery. The key message is that a sudden, severe, "worst ever" headache — especially with other symptoms — is a medical emergency needing immediate help.

How it is treated

A subarachnoid haemorrhage is a medical emergency and is treated urgently in hospital by specialist teams, because it is life-threatening and prompt treatment improves the outcome. The most important step is immediate recognition and action: a sudden, severe headache — especially one that comes on abruptly and is the worst ever experienced (a "thunderclap" headache), or is associated with a stiff neck, vomiting, sensitivity to light, loss of consciousness, confusion, seizures, or stroke-like symptoms — is a medical emergency, and emergency services should be called immediately (do not wait to see if it settles). In hospital, the diagnosis is made urgently, usually with a CT scan of the brain (which often shows the bleeding), and sometimes a lumbar puncture (taking a sample of the fluid around the brain) if the scan is not conclusive; further scans (such as angiography) are used to identify the source of the bleeding, such as an aneurysm. Treatment involves urgent specialist care (neurosurgery and neurology/neuro-intensive care), and depends on the cause: if an aneurysm is the cause, it is treated to stop it bleeding again — either by a procedure from within the blood vessels (endovascular coiling, placing tiny coils in the aneurysm) or by surgery (clipping the aneurysm), depending on the situation; and complications are prevented and managed, such as further bleeding, narrowing of the brain’s blood vessels, raised pressure in the brain (which may need treatment, for example draining fluid), and other effects, with supportive and intensive care. Recovery varies greatly: a subarachnoid haemorrhage is serious and can be fatal or cause lasting effects (such as neurological problems, fatigue, or difficulties with memory or concentration), and rehabilitation and follow-up support recovery for those who survive; some people make a good recovery, particularly with prompt treatment. Because it is life-threatening and time-critical, the key message is recognition and immediate action: a sudden, severe, "worst ever" headache, especially with other symptoms, needs emergency help without delay. It is worth noting that most headaches are not subarachnoid haemorrhages, but the specific feature of a headache that comes on suddenly and is extremely severe (thunderclap) — particularly the first time — should always be treated as an emergency until assessed. The reassuring message, within the seriousness, is that prompt emergency treatment gives the best chance of survival and recovery, and that treating the underlying cause (such as an aneurysm) helps prevent further bleeding.