A Family Doctor's Tale - SUBARACHNOID HEMORRHAGE

DOC I HAVE SUBARACHNOID HEMORRHAGE

A Subarachnoid Hemorrhage is bleeding into the cerebrospinal fluid filled space between the pial and arachnoid membrane of the brain.

A Subarachnoid Hemorrhage occurs when:
1.Rupture of a congenital arterial aneurym (weak arterial wall) is the most common cause.

2.Rupture of an arterial capillary or venous bleeding from one or multiple sites of origin. This can be from high blood pressure or head injury .

3.Capillary damage leading to hemorrhage can occur in certain form of encephalitis.

4.Hemorrhagic diseases such as dengue fever, hemophilia, thrombocytopenia of unknown origin

5.Intracranial tumors such as angioblastic meningioma, glioma, pituitary adenoma and intracranial metastases are rare but possible causes

6.Anticoagulant therapy especially overdosage of warfarin

7.Smoking has been associated with subarachnoid hemorrhage.

The symptoms and signs of a Subarachnoid Hemorrhage are:
The affected person may have:
1.sudden severe headache with no known cause,initially excruciating, intense, aching pain, later becoming dull and throbbing but still severe.

2.difficulty in speaking or understanding

3.difficulty in swallowing

4.severe neck and back pain

5.Pain on attempted head movement

6.dizziness

7.vomiting

8.confusion and agitation

9.loss of concentration and memory

10.sudden vision loss in one eye

11.loss of consciousness

12.convulsions

13.coma and death

14.Stiff neck usually appears with onset of meningeal inflammatory reaction up to 6 to 12 hours after onset suggesting meningeal stretching and herniation of cerebellum into foramen magnum.

Other neurological signs:
1.Pupils unequal

2.paresis of vertical and medial movements of one eye

3.optic field may have round smooth hemorrhages near optic disc,
usually unilateral which will indicate site of bleeding in the brain.

Special investigations:
1.lumbar puncture:
pressure of cerebrospinal fluid may be raised
red blood cells present for first week
protein content raised

2.MRI or CAT scan with intravenous dyes can determine the source of the bleeding

The treatment of Subarachnoid Hemorrhage:
Subarachnoid Hemorrhage is an emergency.
Purpose of treatment is to:
1. preserve life
2. limit the amount of brain damage
3. lessen the extent of disability and deformity
4. prevent recurrence.

Admission to hospital is necessary to determine
1. the cause of the Subarachnoid Hemorrhage
2. the extent of damage to the brain using MRI of the brain
3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).
4. whether Surgery is necessary to stop bleeding or remove a blood clot
5. risk factors for Subarachnoid Hemorrhage are investigated and treated (diabetes, high blood pressure etc)

During the acute phase of Subarachnoid Hemorrhage:
1. A clear airway must be maintained
2. Sufficient fluid and electrolyte intake must be maintained
3. adequate nutrition in the form of glucose, proteins and calories must be given
4. bed rest with adequate nursing care is provided to prevent bed sores etc
5. Proper medicines are given

Once the Subarachnoid Hemorrhage is stable:
The Subarachnoid Hemorrhage patient is started on a rehabilitation programme.
This will include
a.exercises to strengthen his muscles,
b.speech training for patients with dysphasia (difficulty in talking)
c.training on how to carry out his daily activities.
d.advice about his diet

Immediate care improves the chance of a complete recovery.

A Subarachnoid Hemorrhage can be very devastating and depressing for a patient.
He will feel that part of his body and brain function is incapacitated.
Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends

Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:
Please do:
1.be understanding and patient.

2. keep the patient cheerful and hopeful

3.learn how to help him with the diet, daily exercises and other care necessary for him

4.allow the person more time to do any task

5.encourage and praise the patient to do as much as possible for himself at his own pace.

6.involve the person in family discussions and activities.

7.be encouraging and praise his daily efforts.

Prognosis of subarachnoid hemorrhage:
1.Recurrence may occur

2.Can be life threatening