While an ICH causes blood to leak into brain itself, a subarachnoid hemorrhage occurs when blood spills into the space surrounding the brain.  This type of hemorrhage has many possible causes, but is usually the result of a ruptured aneurysm. An aneurysm is a balloon-like bulging of an artery’s wall.  As it enlarges, the vessel becomes weak and more likely to break.

More than half of the 30,000 strokes resulting from subarachnoid hemorrhages are caused by a ruptured aneurysm.

Symptoms
Typically there are no warning signs of an SAH. Occasionally, an aneurysm is detected through a “warning leak”.  These small leaks may cause headaches weeks prior to a more damaging SAH. The symptoms of a SAH include:

Sudden severe headache—often described as the “worst headache of my life”
Vomiting or nausea, especially when combined with other symptoms such as headache.
Intolerance to light
Stiff neck
Loss of consciousness, especially when combined with a severe headache

Treatment
Treatment of SAH (subarachnoid hemorrhage) targets the cause of bleeding and its related complications.  Ruptured aneurysms are generally repaired in one of two ways—direct surgery to clip the aneurysm from the outside and seal the artery where the aneurysm was removed or treating the aneurysm from inside the vessel. Operating on the aneurysm from the inside is done by guiding a special catheter device through the brain until it reaches into the aneurysm.  Once there, the device reaches into the aneurysm and places a small metal coil inside to stabilize the aneurysm wall and prevent blood from entering.

A vessel-narrowing condition called vasospasm is also a common cause of death and disability following SAH.  Vessels in vasospasm become irritated by blood and begin to spasm.  As the vessels narrow, it becomes more difficult to supply surrounding brain tissue with enough blood to survive.  This condition occurs in at least 30 percent of all subarachnoid hemorrhages and lasts for two or more weeks after the first vessel rupture.

Vasospasm treatment often includes the use of the oral medication, nimpdipine. Taking the medication exactly as prescribed is critical to control the condition.  Doctors may also manage vasospasm by closely monitoring the pressure, volume and concentration of blood in the brain.