Subarachnoid Hemorrhage

You have been diagnosed with subarachnoid hemorrhage – what does this mean?

A diagnosis of subarachnoid hemorrhage means that bleeding has occurred in the space surrounding the brain. Hospitalization in an Intensive Care Unit or a specialized Neurosurgical Unit is usually required, where our team closely monitors intracranial pressure, breathing, and your neurological status.

This is a serious but treatable condition. Our goals are: to eliminate the risk of re-bleeding from the aneurysm, to prevent complications (such as vasospasm and hydrocephalus), and to guide you toward a safe recovery.

What exactly is subarachnoid hemorrhage?

The brain is surrounded by three thin membranes (the meninges). Between two of these lies the “subarachnoid space,” where cerebrospinal fluid circulates. When an aneurysm ruptures, blood floods this space and severely irritates the brain.

This results in the sudden, explosive headache many patients describe as “the worst headache of my life,” along with other neurological symptoms.

Why did this happen to me? Risk factors

In most patients, subarachnoid hemorrhage is caused by rupture of a pre-existing cerebral aneurysm that had remained “silent” for years without symptoms.

Known risk factors include:

• High blood pressure
• Smoking
• Heavy alcohol consumption
• Use of cocaine or other stimulant drugs
• Family history of aneurysms or SAH
• Genetic conditions (e.g., polycystic kidney disease)

Importantly: this is not your fault. Even in the absence of identifiable risk factors, SAH can occur. Our role is to stabilize the situation and reduce the risk of recurrence.

What are the symptoms and potential complications?

Typical symptoms include:

• Sudden, severe headache (“like an explosion”)
• Nausea, vomiting, sensitivity to light
• Neck stiffness
• Confusion, drowsiness, or loss of consciousness
• Focal neurological deficits (weakness, speech or vision disturbances)
• Seizures in some patients

Possible complications without appropriate monitoring:

• Rebleeding of the aneurysm
• Vasospasm – narrowing of blood vessels with risk of stroke
• Hydrocephalus – accumulation of fluid around the brain
• Memory, concentration, and mood disturbances

How is the diagnosis made?

Diagnosis is based on:

• Brain CT scan – usually sufficient to detect bleeding.
• CT angiography (CTA) – identifies whether an aneurysm is present and its location.
• Lumbar puncture – in rare cases where CT is negative but clinical suspicion remains high.
• Digital subtraction angiography (DSA) – the most detailed study of cerebral vessels, particularly prior to endovascular treatment.

Who needs surgery and when?

Our primary objective is to secure the aneurysm promptly to prevent rebleeding. This applies to nearly all patients with aneurysmal rupture.

Timing and method depend on:

• Your neurological condition (Hunt–Hess grade)
• The size and location of the aneurysm
• Coexisting medical conditions (heart, lungs, kidneys)

In clinically stable patients, we aim for early treatment of the aneurysm within the first 24–72 hours.

What treatment options are available?

The two primary approaches are:

• Endovascular treatment (coiling / stenting) Through a catheter introduced via the groin or wrist, we access the aneurysm and fill it with coils or reinforce it with a stent, preventing further blood flow into the aneurysm.
• Microsurgical clipping Through a craniotomy, a specialized clip is placed at the base of the aneurysm to permanently exclude it from the circulation.

Additional measures may include:

• External CSF drainage in cases of hydrocephalus
• Treatment of vasospasm with medication and endovascular techniques

What should I expect in the hospital?

In most cases, you will initially be treated in an ICU or specialized Neurosurgical Unit. There:

• Your blood pressure, heart function, and breathing are continuously monitored
• Frequent neurological assessments are performed
• Immediate CT imaging is available if your condition changes
• You receive intravenous medications for blood pressure control, vasospasm prevention, and pain

Length of hospitalization can range from a few days to 2–3 weeks, depending on the severity of the initial hemorrhage and the presence of complications.

What is recovery like and what is the prognosis?

Prognosis depends largely on the severity of the initial hemorrhage. Patients with milder presentations may achieve excellent functional recovery.

During recovery, patients commonly experience:

• Fatigue and reduced stamina
• Memory, concentration, and processing-speed difficulties
• Anxiety, irritability, or mood changes

With structured neurorehabilitation (physical therapy, occupational therapy, neuropsychological support), many patients gradually return to work and daily activities over the following months.

What changes in my daily life?

• Avoid smoking and substances such as cocaine, which increase risk
• Strict control of blood pressure and cholesterol
• Gradual return to physical activity under medical guidance
• Caution with night shifts or high-stress environments for a period of time
• Adherence to prescribed medications (e.g., nimodipine, antihypertensives)

When should I contact my doctor or go to the hospital immediately?

• New, sudden, or very severe headache
• Sudden weakness in a limb, speech or vision problems
• Persistent vomiting, high fever, or confusion
• Rapid deterioration of balance or consciousness