|
Subarachnoid Hemorrhage
Subarachnoid hemorrhage refers to bleeding in a specific area inside the head adjacent to the brain. This represents a SERIOUS cause of headache in both the young and old. Bleeding of this type occurs most often secondary to head trauma. It may also occur secondary to a ruptured aneurysm. An aneurysm is a defect in a blood vessel supplying the brain (cerebral aneurysm). This area of weakening in the vessel wall may "balloon out" (expand), and rupture. Some people are born with a cerebral aneurysm (congenital aneurysm). Aneurysms may also be acquired, through the effects of long standing high blood pressure. Common symptoms of a subarachnoid hemorrhage include the sudden onset of a severe ("thunderclap") headache that "throbs" and increases in intensity with any head motion, or when lying down. These patients will often state, "this is the worst headache of my life." The headache may be accompanied by nausea, confusion, lethargy, or sleepiness that may progress to unconsciousness, or coma. Evaluation will include history (for previous severe headaches) and physical examination. The most important tests will be a CT-scan of the head or an MRI scan, which can reveal subarachnoid bleeding. The lumbar puncture, or spinal tap is also an excellent means of diagnosing this problem (the fluid that is
retrieved will be bloody when it should be normally clear). A special test known as a cerebral angiogram is used to identify the aneurysm. Treatment will be based on the findings of the CT-scan. Consultation with a Neurosurgeon will be necessary. The Neurosurgeon will decide whether surgery is appropriate. In the case of a large subarachnoid hemorrhage, prognosis is guarded. Total recovery without neurologic deficit is unusual in many cases.
|
