Subarachnoid Haemorrhage - Medical Negligence Lawyers
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A subarachnoid haemorrhage is bleeding around the brain between the dura of the brain and the skull. It occurs at a time when a blood vessel in or outside the dura ruptures and does not stop bleeding. The subarachnoid space fills with blood quite quickly.
Patients suffering an acute subarachnoid haemorrhage will experience the sudden onset of a severe headache (the worst headache they have had) and will have neck pain, nausea and vomiting. Because it is such a fast output of blood, there is a sudden onset of a loss of consciousness and death.
A subarachnoid haemorrhage is usually caused by a rupture of a cerebral aneurysm near the base of the skull. A cerebral aneurysm is an irregular or bulging aspect of an artery. The bulging artery has a thin wall and can easily rupture.
The actual cause of cerebral aneurysms is not clear. They can be congenital or can develop in childhood. They grow slowly and can be multiple in nature. People who are of any age can get a subarachnoid haemorrhage, including teenagers and the elderly. Slightly more women get the condition when compared to men. People can get a subarachnoid haemorrhage from trauma as well. A hit to the head can break blood vessels just beneath the skull, leading to a haemorrhage that progresses rapidly.
The diagnosis of a subarachnoid is best made with a CT scan or lumbar puncture. The lumbar puncture is helpful because it will she bleeding down to the level of the lumbar spine. A cerebral aneurysm will be necessary to find the exact source of the pain, using x-ray and contrast dye. If the subarachnoid haemorrhage is stable enough, surgery can be done to tie off the aneurysm and clean out the bleeding in the subarachnoid space.
Because the subarachnoid haemorrhage is life-threatening, patients need to be stabilized and sent to a specialty trauma center where a burr hole in the skull often relieves some of the intense pressure on the brain. Cardiac arrhythmias and pulmonary edema are common complications of this condition. Neurosurgeons need to worry about bleeding happening again or the onset of hydrocephalus.
There is a high morbidity and mortality with subarachnoid haemorrhages in the range of 10 percent who die before even reaching the hospital and 40 percent who will die while in the hospital before a month is up. If there is a ruptured aneurysm, it needs to be clipped or coiled to make sure it doesn’t bleed again. Those that die will often die from cerebral vasospasm or from hydrocephalus. There are often coexisting medical problems that increase morbidity and mortality.
There are rare causes of a subarachnoid haemorrhage which include:
- Arterial dissection
- Cerebral arteriovenous malformations (AVMs)
- Septic aneurysms
- Dural arteriovenous fistula
- Bleeding disorders
- Pituitary apoplexy
- Amyloid angiopathy
- Using cocaine or methamphetamines
There are several predisposing factors or contributory factors to getting a subarachnoid haemorrhage. These include:
- Having high blood pressure that is not properly treated with antihypertensives
- Having a smoking history or actively smoking at the time of the bleed
- Drinking heavily, especially if you are a binge drinker
- Having a first degree relative who has had a subarachnoid haemorrhage, which gives a four percent chance of having your own haemorrhage
- Having a known, heritable connective tissue disease like Marfan’s syndrome or Ehlers-Danlos syndrome
The incidence of subarachnoid haemorrhage is about 3,000 cases per year Australia or about 0.06 to 0.16 per 1000 people per year in Australia. Risk increases with age. The mean age at onset of the haemorrhage is about 50 years with a prevalence of women over men. If you have a first degree relative who has had a subarachnoid haemorrhage from an aneurysm, you have four times the incidence of having your own subarachnoid haemorrhage.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here