What to Do If You Experience Subarachnoid Hemorrhage After a Fall
Subarachnoid hemorrhage (SAH) following head trauma is often not life-threatening, especially when it's purely due to external injury. In cases of traumatic subarachnoid hemorrhage—where bleeding occurs in the space between the brain and the surrounding membrane—conservative medical management is usually sufficient. Most patients recover well within about a week as the blood gradually gets reabsorbed by the body, with symptoms subsiding and neurological function returning close to normal.
Understanding Traumatic vs. Spontaneous SAH
It's crucial to differentiate between traumatic and spontaneous subarachnoid hemorrhage. While both involve bleeding into the subarachnoid space, their causes and implications differ significantly. Traumatic SAH results directly from physical impact, such as a fall or blow to the head. However, in some instances, what appears to be an injury-related bleed might actually stem from a prior internal event.
When Bleeding Precedes the Fall
Some individuals experience a spontaneous SAH caused by a ruptured brain aneurysm or arteriovenous malformation (AVM), which can lead to sudden loss of consciousness and a subsequent fall. In these cases, the hemorrhage occurs first—triggering the fall—not the other way around. This distinction is vital for proper diagnosis and treatment planning.
Experienced neurologists and radiologists can often identify clues on imaging scans—such as the location and pattern of bleeding—that suggest a non-traumatic origin. For example, spontaneous bleeds tend to cluster around the base of the brain or in specific vascular territories, unlike trauma-induced bleeding, which may follow the site of impact.
Necessary Diagnostic Steps
If there's any suspicion that the SAH was spontaneous rather than solely trauma-induced, further diagnostic testing becomes essential. A non-contrast head CT scan is typically the first step, but additional imaging such as CT angiography (CTA) or cerebral angiography may be required to detect underlying vascular abnormalities like aneurysms or AVMs.
These advanced imaging techniques allow doctors to visualize blood vessels in high detail, helping them pinpoint weak spots or malformations that could pose future risks if left untreated.
Treatment Options Based on Cause
Once the root cause is identified, appropriate interventions can be planned. For patients with a ruptured aneurysm, treatment options include:
- Surgical clipping: A neurosurgeon places a small metal clip at the base of the aneurysm to prevent further bleeding.
- Endovascular coiling or embolization: A minimally invasive procedure where a catheter is guided through the arteries to fill the aneurysm with coils or other materials, sealing it off.
In cases involving arteriovenous malformations, surgical removal, embolization, or stereotactic radiosurgery may be recommended depending on the size, location, and complexity of the lesion.
Early detection and accurate diagnosis are key to preventing rebleeding, which carries a much higher risk of severe disability or death. Therefore, anyone who experiences a head injury followed by symptoms like severe headache, confusion, nausea, or loss of consciousness should seek immediate medical evaluation—even if the incident initially seems minor.
In summary, while many cases of post-fall subarachnoid hemorrhage resolve with conservative care, ruling out a spontaneous origin is critical. Proper imaging and specialist assessment ensure that potentially dangerous underlying conditions are not overlooked, ultimately improving patient outcomes and long-term safety.