Subarachnoid Hemorrhage Treatment

Some people never recover from brain hemorrhages, including approximately 75% of those who suffer subarachnoid hemorrhages. The surviving 25% can expect long-term deficits and disability due to the damage their brain suffered. A subarachnoid hemorrhage is bleeding that occurs into the subarachnoid space between the brain and the arachnoid tissue, a thin membrane between the brain tissue and the inner skull bone. The bleeding occurs when a cerebral blood vessel ruptures. The effect of this rupture depends on the location of the vessel, the extent of the rupture, the extent of the tissue affected, and the severity of blood loss/accumulation. The nearly universal effects that can be expected from a brain hemorrhage are swelling of the brain and increased pressure within the cranium. The extent of this, of course, depends on the above factors.

Treatment to Prevent Brain Hemorrhage

Brain aneurysms are a top cause of subarachnoid hemorrhages. Aneurysms are areas of a blood vessel that have been weakened, often due to high blood pressure, but also by lipid deposition (which is exacerbated by smoking) and congenital disease. Treating vessels before they rupture is one way to prevent a life threatening bleed. Various technologies are now available for addressing known vessel abnormalities, such as the berry aneurysm, the most clinically significant cause of subarachnoid hemorrhage according to medical textbooks (Cotran, Kumar, and Collins. Robbins Pathologic Basis of Disease, 6th edition).

Aneurysms and weakened vessels can be surgically removed or corrected to prevent hemorrhage, but the approach depends on the location, size, and type of aneurysm, as well as the condition and medical history of the patient. However, the options include the more recently developed endovascular embolization (or coiling), the more commonly used and time tested clipping, or the more invasive open cranial surgery known as occlusion and bypass.

For more information on subarachnoid hemorrhages caused by aneurysms, see the Brain Aneurysm Foundation.

Treatment after Subarachnoid Hemorrhage

After a brain hemorrhage occurs, the goals for treatment are to repair the cause of bleeding, prevent or minimize brain damage, and relieve the symptoms. If the hemorrhage occurred due to injury, surgery may be done to remove the blood and relieve the pressure on the brain. If an aneurysm ruptured, the vessel requires repair, as discussed above, but also requires relieving the pressure on the brain. Sometimes this is done by removing part of the skull bone, called a craniotomy. A drainage tube may also be inserted for this purpose.

Life support and blood pressure regulation are often needed for more severe hemorrhages. Anti-seizure medications, pain relievers, and anti-anxiety medications may also be used to alleviate symptoms. Bed rest and pharmacological relief for stressful activities may be prescribed as well.  Any treatment is pursued with the goal of saving the patient’s life and preventing further complications.