What to Do in Case of Acute Subarachnoid Hemorrhage

Understanding Subarachnoid Hemorrhage: A Medical Emergency

Subarachnoid hemorrhage (SAH) is a life-threatening condition characterized by bleeding into the subarachnoid space—the area between the brain and the thin tissues that cover it. This type of hemorrhage typically results from the rupture of a weakened blood vessel, most commonly an intracranial aneurysm. When blood spills into this sensitive region, it can cause sudden neurological damage, increased intracranial pressure, and potentially fatal complications if not treated immediately.

Sudden Onset Symptoms Require Immediate Action

One of the hallmark signs of SAH is a sudden, severe headache—often described by patients as "the worst headache of my life." This may be accompanied by nausea, vomiting, neck stiffness, confusion, or even loss of consciousness. If someone experiences these symptoms abruptly, emergency medical attention is critical. Delaying treatment significantly increases the risk of rebleeding, brain injury, or death. Call emergency services right away and avoid any movement that could elevate blood pressure.

First Aid Measures Before Hospital Arrival

While waiting for medical help, keep the patient as still and calm as possible. Position them with their head slightly elevated and turned to one side to prevent aspiration if vomiting occurs. This positioning helps maintain an open airway and reduces the chance of choking on saliva or vomit. Clear any visible secretions from the mouth gently but promptly to avoid respiratory blockage.

Avoid unnecessary movement or long-distance transportation. Seek care at the nearest hospital equipped for neurosurgical emergencies. Rapid stabilization and diagnosis are far more important than reaching a distant specialized center without proper support during transit.

Safer Transport with Medical Supervision

If transfer is necessary, it should be done under the supervision of trained medical personnel who can monitor vital signs and intervene if the patient's condition deteriorates. Prior to transport, doctors may administer medications to control blood pressure, reduce intracranial pressure (such as mannitol), and provide sedation or pain relief to minimize agitation and stress.

Patients must remain on strict bed rest during transit. Minimizing physical jolts and vibrations is essential to prevent further bleeding. In cases of significant bleeding causing hydrocephalus, procedures like ventriculostomy or lumbar puncture may be performed to drain cerebrospinal fluid and relieve pressure on the brain.

Diagnosis and Confirmatory Testing

Once stabilized, rapid diagnostic imaging is crucial. A non-contrast head CT scan is typically the first-line test and can detect blood in the subarachnoid space with high accuracy within the first 24 hours. If CT results are inconclusive, a lumbar puncture may be performed to check for xanthochromia (yellowish discoloration of cerebrospinal fluid due to broken-down red blood cells).

After confirming SAH, identifying the underlying cause becomes the next priority. Most often, the culprit is a ruptured cerebral aneurysm, though arteriovenous malformations (AVMs) or other vascular abnormalities can also be responsible. Advanced imaging such as CT angiography (CTA) or cerebral angiography is used to visualize blood vessels and locate the source of bleeding.

Definitive Treatment: Clipping vs. Coiling

Once an aneurysm is identified, prompt intervention is required to prevent rebleeding, which carries a high mortality rate. Two main treatment options exist: surgical clipping and endovascular coiling.

Surgical clipping involves opening the skull (craniotomy) and placing a metal clip at the base of the aneurysm to stop blood flow into it. Endovascular coiling, a less invasive option, uses a catheter inserted through the groin to navigate to the brain and fill the aneurysm with platinum coils, promoting clot formation and sealing off the weak spot.

Ongoing Care and Recovery Outlook

Continuous monitoring of blood pressure is essential throughout treatment, as hypertension can trigger rebleeding. Equally important is maintaining emotional stability—stress and anxiety can elevate blood pressure and worsen outcomes. Patients benefit from a calm environment, psychological support, and careful management of pain and discomfort.

Recovery varies widely depending on the severity of the bleed, speed of treatment, and presence of complications like vasospasm or stroke. With timely diagnosis and expert care, many patients can achieve meaningful recovery, though rehabilitation may be needed to regain cognitive or motor functions.

In conclusion, acute subarachnoid hemorrhage demands immediate recognition, rapid response, and coordinated neurocritical care. Public awareness of its warning signs and the importance of urgent hospitalization can save lives and improve long-term outcomes.