Subarachnoid Hemorrhage (SAH) Symptoms, Causes, Treatment, and Long-Term Outlook

By Dr. Rajan Shah in Centre for Neurosciences

Apr 24 , 2023 | 3 min read

What is a Subarachnoid Hemorrhage (SAH)?

A subarachnoid hemorrhage (SAH) occurs when blood leaks into the space between the brain and the tissue covering it, often due to a ruptured aneurysm or head trauma. This medical emergency disrupts normal brain function, leading to severe complications and is often life-threatening. Immediate medical attention is essential for individuals exhibiting symptoms.

How Serious is a Subarachnoid Hemorrhage?

Subarachnoid hemorrhage is a catastrophic event, with a high risk of immediate and long-term brain damage. Nearly 30% of people experiencing SAH may not survive to reach the hospital, while many survivors endure long-term disability. Damage occurs primarily due to two factors: initial bleeding and restricted oxygen and nutrients reaching the brain.

Survival and Recovery Rates: Only about 25% of SAH survivors regain normal life activities, while others may require ongoing care.

How Common is Subarachnoid Hemorrhage?

SAH is less common than other types of strokes but accounts for about 6% of all stroke cases. It affects roughly 6–10 individuals per 100,000 annually, often impacting a younger population than other stroke types. Key risk factors include high blood pressure, smoking, and aneurysms.

Are There Warning Symptoms for Subarachnoid Hemorrhage?

Some people experience warning signs before a subarachnoid hemorrhage. These symptoms often present hours or days prior and may include:

Sudden, severe headache (often called a thunderclap headache)
Double vision or vision loss
Neck pain and stiffness

Subarachnoid Hemorrhage Symptoms

Common SAH symptoms typically appear suddenly and with severity, leading patients to seek immediate help. These include:

Severe headache (“worst headache of life” sensation)
Nausea and vomiting
Stiff neck
Slurred speech
Loss of consciousness or seizures
Vision issues (double vision, temporary vision loss)
Confusion and weakness on one side of the body

If experiencing these symptoms, seek emergency medical help immediately. Rapid intervention can significantly impact outcomes.

How to Recognize SAH in Yourself or a Family Member?

Symptoms like sudden confusion, speech difficulties, and trouble walking may indicate SAH. Key warning signs include:

Sudden, severe headache
Vision impairment
Loss of balance or coordination

If any of these symptoms persist for more than a few minutes, don’t delay; seek emergency assistance immediately.

Long-Term Outlook for Patients with Subarachnoid Hemorrhage

Improvement can continue for up to 18 months post-SAH, though many patients experience some degree of impairment. Factors leading to better outcomes include smaller bleeds, younger age, and early medical intervention.

Statistics on Recovery: 1 in 4 patients fully recovers; however, many experience personality changes or other cognitive impacts.
Rehabilitation: Physical therapy, occupational therapy, and psychological support often aid in a return to daily activities.

Subarachnoid Hemorrhage Treatment

Initial treatment focuses on stabilizing the patient and preventing further bleeding. Specific treatments may include:

Medication to manage blood pressure, prevent seizures, and control brain swelling
Surgery: SAH from an aneurysm may require surgery to prevent rebleeding. Procedures include clipping or coiling the aneurysm to control bleeding.

Hospitalization can last from two weeks to several months, depending on the hemorrhage's severity and complications.

Guidelines for Family and Friends

Supporting a loved one during recovery from SAH requires creating a calm and supportive environment. Suggestions for family members include:

Limiting noise and excessive activity to reduce patient stress
Ensuring the patient follows prescribed therapies, including deep breathing exercises and positioning restrictions
Taking time for self-care to maintain strength for caregiving

Caregivers play a vital role in patient recovery by monitoring health changes and assisting with rehabilitation exercises.

What Happens After Leaving the Neuro Intensive Care Unit?

Upon discharge, the patient’s focus shifts toward recovery and regaining independence. Key aspects of post-hospital care include:

Medication adherence to control blood pressure and prevent complications
Hydration, aiming for 2-3 liters per day for the first few weeks
Avoiding activities like driving, swimming, and traveling for the first three months

Regular follow-ups with healthcare providers and commitment to a healthy lifestyle can improve recovery outcomes.