Subarachnoid haemorrhage

Symptoms of a subarachnoid haemorrhage

The main symptoms of a subarachnoid haemorrhage include:

• an extremely painful headache that starts suddenly and does not go away (called a "thunderclap headache")
• neck pain or a stiff neck
• feeling and being sick
• being very sensitive to light
• having a seizure (fit) or shaking uncontrollably
• fainting, feeling sleepy (drowsy ) or being confused
• drooping on one side of your face, slurred speech, or weakness on one side of your body

A subarachnoid haemorrhage can happen at any time, but it may be more likely when you're doing something like coughing, going to the toilet, lifting something heavy or having sex.

Causes of a subarachnoid haemorrhage

A subarachnoid haemorrhage most commonly affects people who have a bulge in a blood vessel in their brain, called a brain aneurysm.

There's not always an obvious reason why you may have a brain aneurysm.

Some people have them from birth, while others may get them later. You may be more likely to have a brain aneurysm if other people in your family have them.

Most brain aneurysms do not cause problems, but if one bursts it can cause bleeding in the space between the inside of your skull and your brain (subarachnoid space). This type of bleeding is called a subarachnoid haemorrhage.

Subarachnoid haemorrhages can also be caused by :

• a severe head injury
• a problem with the way the blood vessels in your brain have formed (arteriovenous malformation)

Treatment for a subarachnoid haemorrhage

The main treatment for a subarachnoid haemorrhage is surgery to stop the bleeding.

This may be done by:

• removing a small piece of bone from the skull, using a tiny metal clip to seal the burst blood vessel (aneurysm) and then replacing the bone – called neurosurgical clipping
• putting a thin, flexible tube into an artery in your groin or leg, guiding it to where the burst blood vessel is, and passing tiny metal coils up the tube into the aneurysm to block it – called endovascular coiling

You may also have treatment before and after surgery to help the symptoms of a subarachnoid haemorrhage and lower the risk of the bleeding happening again.

This might include medicine to:

• help with pain
• lower your blood pressure
• prevent seizures (fits) or coughing
• stop you feeling sick
• soften your poo to make it easier to go to the toilet
• make sure your blood flows properly

How a subarachnoid haemorrhage affects your life

How a subarachnoid haemorrhage affects your life varies from person to person and depends on where in the brain the bleeding happened and the amount of damage it has caused.

Although it can take months or years to get better, most people improve with treatment and some recover fully.

But a subarachnoid haemorrhage is a very serious condition that can lead to mental and physical disability, and significantly affect your quality of life.

You may experience:

• seizures (fits)
• heart, lung or liver problems
• cognitive difficulties, such as problems with memory, concentration and communication
• depression and mood changes
• feeling restless and extremely tired (fatigue)
• headaches and unusual feelings, like water is trickling in your head or your brain is itchy

A small number of people develop epilepsy after having a subarachnoid haemorrhage.

Recovering from a subarachnoid haemorrhage

You will have regular follow-ups with your doctor and recovery team.

They will talk with you about any possible complications of a subarachnoid haemorrhage and whether you need any further tests or treatment. They may want to check for any problems in your blood vessels, manage other brain aneurysms or treat a build-up of fluid around your brain (hydrocephalus).

They can also give you advice about issues like driving, work, exercise, travel and sex. You may have to stop working for a short time or long term after having a subarachnoid haemorrhage.

You will have therapy (rehab or rehabilitation) to help your recovery. Depending on what you need, rehabilitation may include:

• physiotherapy to help with problems with movement, balance, breathing, swallowing or pain
• speech and language therapy – for communication problems
• cognitive behavioural therapy (CBT) – to help with mood changes, depression and restlessness
• cognitive exercises – to improve issues with things like concentration and memory, for example

Recovery can be slow and frustrating, but the exercises, therapy sessions and activities will help you make progress. Some long-term problems can continue to improve after several months or years.

Help and support after a subarachnoid haemorrhage

As well as support from your doctor and recovery team, you may find it helpful to get emotional support from other people who are recovering from a subarachnoid haemorrhage or other type of stroke, either at a local group or online.

There are also national charities that can offer support and information.

Stroke Association

Information, support and resources for anyone affected by a stroke, including local and online support groups and services.

• Stroke helpline: 0303 303 3100
• Stroke Association charity: support and guidance
• Stroke Association charity: life after stroke