Subarachnoid Hemorrhage

Overview

Subarachnoid hemorrhage is bleeding into the space around the brain, often caused by rupture of a cerebral aneurysm. This is a neurologic emergency that requires immediate diagnosis, stabilization, and specialized neurocritical care.

For the public, the most important message is simple: a sudden, severe, unusual headache with neurologic symptoms should never be ignored. Patients with aneurysmal subarachnoid hemorrhage often require emergency imaging, ICU-level care, and urgent aneurysm securing through endovascular or surgical treatment.

Common symptoms

Symptoms may include:

Sudden, explosive severe headache.
Neck pain or stiffness.
Nausea and vomiting.
Loss of consciousness.
Weakness or speech difficulty.

Emergency action

Call 911 immediately for possible subarachnoid hemorrhage symptoms. Patients should not drive themselves to the hospital.

What happens in the hospital

Evaluation commonly includes:

Emergency CT of the head.
Vascular imaging such as CTA.
Neurocritical care monitoring.
Evaluation for aneurysm or another bleeding source.

Treatment priorities

The priorities in subarachnoid hemorrhage are:

Stabilize the patient.
Identify and secure the source of bleeding.
Prevent rebleeding.
Monitor for vasospasm, hydrocephalus, seizures, electrolyte issues, and other complications.
Support neurologic recovery.

Securing the aneurysm or bleeding source

If an aneurysm is found, treatment is often either:

Endovascular coiling or other catheter-based aneurysm treatment.
Microsurgical clipping.

The choice depends on the aneurysm anatomy, the patient’s condition, and the expertise of the treating cerebrovascular team.

Why specialized care matters

Subarachnoid hemorrhage is not just a bleeding event. It is a complex ICU disease process that can evolve over days. High-level management includes frequent neurologic assessment, prevention of secondary brain injury, and close coordination between neurointerventional, neurosurgical, critical care, and rehabilitation teams.

For patients and families

Families often experience subarachnoid hemorrhage as a sudden shock. Treatment decisions are time-sensitive, and recovery can be unpredictable. The most important priorities early on are rapid diagnosis, expert aneurysm or bleeding-source treatment, and specialized hospital care.