Subarachnoid Haemorrhage
FAQ on bleeding under the covering of brain
Dr Syed Sayed Ahmed
"Sudden severe headache" -- is it an emergency ?
Sudden onset of severe agonising headache in a patient should be regarded as subarachnoid hemorrhage (SAH) until proven otherwise.What is Subarachnoid hemorrhage (SAH)?
Bleeding in the surface or inside the brain or spinal cord most commonly as a result of rupture of cerebral blood vessel aneurysm (swelling caused by the weakening of a wall of a blood vessel) or arteriovascular malformation, in few cases due to hypertension or unknown cause. Associated symptoms include nausea, vomiting, photophobia and neck stiffness. Patient may lose consciousness. Severity of symptoms depends on amount of blood and location of bleed. Many patient die before reaching hospital. Overall mortality is 40 to 50 percent. What should one do?
SAH is a neuro-surgical emergency. Patients must be taken to hospital equipped with CT scan and cerebral angiography facilities. Why urgent treatment is so vital?
- Appropriate initial management can avoid risk of life
- Reduce risk of spasm of blood vessel leading to stroke
- To control fits
- Reduce risk of further bleeding by maintaining optimum blood pressure and control of headache
- Reduce the risk of other serious complications.
Things to remember while the patient is being transferred
1. Analgesia (pain relieve) with paracetamol and codeine
2. Patients should lie flat
3. Preferred transport should be ambulance with paramedic staff
4. If Glasgow coma score is 8 or below, patient should be intubated and ventilated artificially
5. Proper management in right time is the key to better outcome for this life threatening medical condition. Dr Swyed Sayed Ahmed FRCS (UK) is a Consultant Neurosurgeon of Apollo Hospitals, Dhaka.
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