2011 Subarachnoid Haemorrhage
Subarachnoid Haemorrhage This pamphlet will briefly describe what may happen to a person who has a subarachnoid haemorrhage (SAH). We would like to encourage you to read this pamphlet. The nurses and doctors caring for the patient will answer any of your questions. What is inside a brain? The brain is 1 st Ventricle connected to the spinal cord. 2 nd Ventricle Everyone has 4 ventricles that 3 rd Ventricle make cerebrospinal fluid (CSF). Two 4 th Ventricle main groups of arteries supply blood to the brain. For unknown reasons an area on a blood vessel wall can weaken and bulge out to form an aneurysm. Aneurysms differ in shape, size, and location, which determine how hard or easy they are to repair. As the aneurysm wall becomes more and more stretched, it finally may leak or burst open. This is called a subarachnoid haemorrhage (SAH). With every heartbeat, blood is pumped around the brain and into the brain tissue. Blood in the wrong place can cause many problems. 1
Symptoms of a SAH The location of an aneurysm in the brain as well as the amount of bleeding determines the patient s symptoms. The most common symptom is a severe headache often described as the worst ever. Other symptoms may be: Stiff neck Sensitive to lights and sounds Vomiting Problems with moving the arms or legs Problems with speech, eyelid droop, face may appear to move asymmetrically. Unable to wake up Doctors classify the SAH according to the amount of damage caused by the blood. The doctor may speak of a SAH Grade 1, 2, 3, 4, or 5. A patient with a Grade 1 has a small amount of bleeding. A patient with a Grade 5 has severe bleeding inside his/her brain. This person will be in a coma and need a breathing machine. The Grade of the bleed is an important factor in predicting how well the patient may recover. The bleeding inside the brain causes brain damage which will remain. Damaged brain cells do not repair themselves. When the brain is damaged, it may swell and the space inside the head becomes very tight. What to expect Often patients who have had a SAH will have a drainage 2
tube in their head called a ventricular drain. Everyday the brain makes new CSF and the old CSF is reabsorbed. Sometimes the normal pathway of the CSF gets blocked. CSF continues to be made and the pressure will rise in the ventricles. This is called hydrocephalus. The doctor places the tube in the ventricle to drain CSF and decrease the pressure. This tube inside the ventricles (inside the head) is connected to a special drainage system. This liquid may be clear, brownish, or bloody. There may be particles in the liquid. While this tube is in place the nurse may obtain a numerical reading on the monitor of the pressure inside the skull (intracranial pressure-icp). The doctor may change treatments based on this number as well as the patient s symptoms. Please ask for an explanation (pamphlet available). Vasospasm Blood in the brain tissue may cause the artery walls to narrow. This is called vasospasm and often occurs in the patient with SAH. If this happens, areas of the brain normally supplied by those arteries are deprived of blood. This condition may cause problems with movement, speech, or problems with waking up. If an area is deprived of an adequate blood supply for a long period of time it will become a stroke. 3 Placement of a ventricular drain
Treatments Surgery or Coiling The purpose of both procedures is to make the artery wall strong again. The consent of the patient/family is needed to do either procedure. The decision to do one procedure or the other is based on the patient s condition, aneurysm location and the type of aneurysm. The doctor decides when the procedure is to be done. Brain surgery may be needed to locate and repair the aneurysm. Coiling is used to repair an aneurysm without brain surgery. The coils are inserted into the aneurysm using a special intravenous placed into a large blood vessel. On occasion, an aneurysm may form again several years after the coiling procedure. The doctors and nurses can explain both procedures to you. Both procedures have risks including infection, artery dissection and death. Vasospasm The overall treatment of the patient with vasospasm focuses on preventing the aneurysm from re-bleeding and decreasing complications from the bleeding that has already occurred. To help prevent and deal with vasospasm. The patient usually receives a medication called nimodipine. The patient will receive 2 pills every 4 hours while in hospital. This may be changed to one pill every 2 hours if the medication causes the blood pressure to go down. Spasm can happen on and off and can last up to 21 days. 4
The patient will receive intravenous fluids. A special intravenous tubing (arterial line) may be used to check the blood pressure. Ask the nurse to explain this (pamphlet available). The patient may also receive medications to increase his/her blood pressure as this will help the blood flow through the narrowed blood vessels. Patients may receive a blood product called albumin, which also helps to increase the blood flow. The patient/family will need to sign a consent before albumin (blood product) is given. On occasion, a patient may need treatment for a blood pressure that is too high. The doctor may do a test called transcranial dopplers to check for and measure vasospasm. Please ask for an explanation. A central line may be inserted to closely monitor fluid status (pamphlet available). Length of Stay How long a patient needs to be in hospital depends on if the patient had brain surgery or coiling and the damage done by the bleeding. Occasionally even though the doctors can see blood in the brain they cannot find an aneurysm. These patients will be on bed rest for a period of time. 5
Looking for more health information? Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to HTTP://publiclibraries.ns.ca Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia www.cdha.nshealth.ca Prepared by: Critical Care Emergency Resource Team Illustrations by: Page 1-LifeART Health Care 1 Images, Copyright 1994, TechPool Studios Corp. USA Page 3-Janice Bennett-Mumford Designed and Printed by: Capital Health Audio Visual and Printing Departments The information in this brochure is provided for information and education purposes only. The information is not intended to be and does not constitute healthcare or medical advice. If you have any questions, please ask your healthcare provider. WL85-0242 Rev.07/2011 The information in this pamphlet is to be updated every 3 years.