How To Treat A Subarachnoid Hemorrhage

November 6, 2023

A subarachnoid hemorrhage occurs when there is bleeding between the brain and the subarachnoid space surrounding it. Most cases present with a sudden and severe headache. It's also possible for the headache to cause vomiting, nausea, and loss of consciousness. In most cases, the bleeding occurs when an aneurysm in the brain ruptures. An aneurysm is an abnormal bulge that forms in a blood vessel. Some aneurysms can be treated before they rupture, while others can only be monitored. The bleeding can sometimes also be a result of trauma and injury. In rarer cases, other health issues and blood vessel problems can cause this type of bleeding. Abnormal tangles of blood vessels called arteriovenous malformations can cause this bleeding in the brain.

Surgical Clipping

Surgical clipping is used to treat aneurysms, which are abnormal bulges in the wall of an artery, and sometimes this procedure is done as a preemptive measure to keep the aneurysm from causing bleeding. However, the procedure is often done as part of a treatment and damage control after the aneurysm has already caused bleeding. By themselves, aneurysms often cause no symptoms. In fact, many individuals may not be aware they have an aneurysm at all. But the larger an aneurysm becomes, the thinner the walls of the artery are stretched. It can become thin enough to rupture or leak, which can then lead to a subarachnoid hemorrhage. During a surgical clipping procedure, a neurosurgeon will open the patient's skull and put a clip across the aneurysm's neck. This keeps more blood from entering it, which in turn prevents or stops existing bleeding. It also prevents the aneurysm from growing larger. The main goal of the surgery is to keep blood from flowing into the aneurysm without blocking off any of the small arteries near it.

Certain Medications

A subarachnoid hemorrhage is an emergency medical situation, as if the condition isn't treated immediately, it can lead to permanent brain damage or death. The initial treatments focus on helping stabilize the patient's condition. This might include the administration of different medications to help manage pain, or the use of general anesthesia so a patient can undergo neurosurgery. The one drug approved to treat a subarachnoid hemorrhage is nimodipine, which is a calcium channel blocker. Unlike most other medications on the market, nimodipine is specifically used for the treatment of a subarachnoid hemorrhage. When individuals experience abnormal bleeding, their body will naturally respond by narrowing the vessel in question so the flow slows. But when the blood vessel is in the brain, stopping the flow of blood does more harm than good. It deprives the brain of oxygen, leading to further brain damage. Nimodipine relaxes the narrowed blood vessels to encourage blood flow and reduce brain damage. The drug has not been approved for any other uses.

Endovascular Embolization

Endovascular embolization is a major surgical procedure that helps treat abnormally formed blood vessels in the brain. While it's most commonly used for malformations in the brain, the procedure can also be used to treat abnormal vessels that cause symptoms in other areas of the body. It's an invasive surgery used as an alternative to open surgery. The goal is to block a certain blood vessel or blood vessels so that blood flow will be cut off from a certain area. Endovascular embolization might be recommended for patients who experience brain aneurysms, uterine fibroid tumors, abnormal circulatory system growths, excessive nosebleeds, or arteriovenous malformations. Arteriovenous malformations (AVMs) are abnormal clumps of blood vessels susceptible to bleeding. They can occur at any point in the body, but they're most likely to cause dangerous symptoms when they form around the spine or brain. Endovascular embolization is sometimes used as a primary form of treatment, or it can be used in conjunction with another surgery. Sometimes the purpose of endovascular embolization is to make another surgery safer.

External Ventricular Drain Placement

An external ventricular drain, which is placed during a surgical procedure, is used to redirect cerebrospinal fluid (CSF). It can be used for a variety of different medical conditions, though the main goal is to alleviate increased intracranial pressure that occurs as a result of leaking cerebrospinal fluid. Not everyone who has a subarachnoid hemorrhage will experience CSF leakage, but if they do, a drain placement is one of the most common ways to alleviate this. External ventricular drain placement is typically used to treat hydrocephalus, which is a symptom that can occur after a stroke or other neurological issues. These drains are flexible plastic catheters and are managed by the nurses and physicians in the intensive care unit. They are typically used as short-term, emergency solutions to hydrocephalus. The underlying cause of the hydrocephalus must be addressed. If there's no way to stop the hydrocephalus, the drain might be converted to a permanent cerebral shunt.

Shunt Placement

Shunt placement is the more permanent version of external ventricular drain placement. Shunts are hollow tubes placed in the brain or spine by a neurosurgeon. They drain excess cerebrospinal fluid, redirecting it within the body to a place where the body can reabsorb it. A shunt procedure is used to manage hydrocephalus, which can be a complication following a subarachnoid hemorrhage. The procedure is usually used when hydrocephalus cannot be cured or stopped. A permanent shunt is completely internal, unlike an external drain. It helps relieve the symptoms that come with hydrocephalus, including a lack of bladder control, mild dementia, and difficulty with walking. Doctors will sometimes do a lumbar puncture to decide whether the patient is a good candidate for a shunt. If the lumbar puncture improves symptoms, a shunt may provide the same relief.

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