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Subarachnoid Hemorrhage

WHAT YOU NEED TO KNOW:

Subarachnoid hemorrhage (SAH) is bleeding inside your brain from a ruptured (burst) blood vessel. Blood collects in the area underneath the membrane that surrounds your brain, called the subarachnoid space. SAH can occur when an abnormal blood vessel or an aneurysm bursts. An aneurysm is a bulging area of a blood vessel. A head injury can also cause a burst blood vessel. SAH is a type of stroke that is life-threatening with or without treatment.

Subarachnoid Hemorrhage

WHILE YOU ARE HERE:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  • An IV is a small tube placed in your vein that is used to give you medicine or liquids. You may also need a central line with your IV. It is put into a large vein near your collarbone, in your neck, or in your groin. You may need a central line to receive medicines and to monitor pressure in your veins.
  • Bed rest: Your caregiver may place you on strict bed rest. This means you will not be able to get up until your condition has improved. He may also raise the head of your bed to reduce the pressure in your skull.
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  • Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity. You may receive an ECG to watch for heart rate or rhythm problems, or heart muscle injury.
  • A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. You may receive oxygen through a mask or ventilator if you are not breathing well on your own.
  • Endotracheal (ET) tube: An endotracheal tube may be put into your mouth or nose. It goes down into your windpipe to help keep your airway open and help you breathe. It may be hooked to a ventilator (breathing machine), and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.
  • Nasogastric (NG) tube: An NG tube is put into your nose, and passed down your throat into your stomach. Food and medicine may be given through an NG tube if you cannot swallow. Your tube will be removed once you are able to eat normally.

Tests:

  • CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your skull and brain. A CT scan shows bleeding in the subarachnoid space.
  • Lumbar puncture: This procedure may also be called a spinal tap. You will need to lie still during this test. Your caregiver may numb a small area of your back, and place a needle inside the area. He will remove fluid from around your spinal cord. The fluid will be tested for blood.
  • Blood tests: Your blood will be tested to check your kidney and heart function. Your blood's ability to clot will also be tested.
  • Angiography: X-rays are taken of your blood vessels. This test may show if you have any other aneurysms in your brain. It may also show how badly you are bleeding, and what type of surgery you may need. Your caregiver will inject dye called contrast into your IV. This will help the pictures show up better on a monitor. Tell your caregiver if you have ever had an allergic reaction to contrast dye.
  • MRI: This scan contains powerful magnets and a computer that take pictures of your brain. It will also take pictures of the blood vessels and structures in your head. Tell caregivers if you have any metal in or on your body. Metal can cause serious injury. Tell caregivers if you cannot lie still or are anxious or afraid of closed spaces. You may need this test to see if SAH has blocked blood from flowing to certain areas of your brain.
  • Transcranial Doppler ultrasound: Your caregiver will hold a probe against your head to measure sound waves in your brain. The sound waves appear on a monitor. The test may show if the blood vessels in your brain are closing and blocking blood flow.

Medicines:

  • Antihypertensives: These reduce high blood pressure. This may help prevent the return of SAH. It is also used to prevent stroke and heart or kidney damage caused by SAH.
  • Calcium channel blockers: These help prevent further brain injury after SAH has occurred.
  • Anticonvulsants: You may be given this medicine to help prevent seizures.
  • Antianxiety or sedative medicine: This medicine may be given to treat seizures.
  • Pain medicine: You may receive medicine to decrease or take away pain. Do not wait until the pain is severe before you ask your caregiver for your medicine.
  • Other medicines: You may receive medicine to prevent or treat SAH problems. These may include medicine to treat increased pressure in your brain, fever, stomach ulcers, or a high blood sugar level.

Surgery:

  • Endovascular coils: Coils are placed inside your aneurysm to prevent it from filling with blood. This may prevent the aneurysm from bursting.
  • Surgical clipping: Your aneurysm is clipped off to help prevent it from bursting.

Complication management:

  • Drainage tubes: Your caregiver may need to place drainage tubes in your lower back or in your brain after surgery. This will help drain spinal fluid from your brain. The tubes may be in place for a short or long term.
  • Brain imaging tests: Your caregiver may perform imaging tests such as a CT scan right after surgery. This will show him if you still need further treatment or surgery.

Blood clot prevention:

Physical activity helps prevent blood clots. Caregivers will help you be as active as possible. You may also need to wear compression boots or stockings to help prevent clots from forming in your legs.

Therapy:

A physical therapist and an occupational therapist may exercise your arms, legs, and hands. They may also teach you new ways to do things around the house. A speech therapist may work with you to help you talk or swallow.

RISKS:

  • SAH may cause blood vessels in your brain to narrow. This will slow oxygen from reaching your brain and may cause long-term brain damage. Blood clots may form in your brain, and lead to a stroke. SAH may also cause blood clots to form in your body. These problems may be life-threatening. You may not fully recover after SAH. You may not sleep well, think clearly, or be able to work as you did before. You may also feel anxious, tired, or depressed. This may affect your relationships.
  • You may have more than one SAH, or your bleeding may return after treatment. You may need more than one surgery to treat other aneurysms that occur. Radiation from repeated imaging tests may burn your skin or cause hair loss. Pressure in your brain may worsen if your caregiver cannot control your pain. This may worsen your SAH.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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