Suarachnoid Hemorrhage (SAH)
Would you realize if you or someone else was having a brain aneurysm? A whopping 93% of Americans admitted their brain aneurysm knowledge was limited to non-existent, according to the Lisa Colagrossi Foundation (TLCF). One aneurysm ruptures every 18 minutes in the US. They are more common on women than men.
The bulge-like weakness in the brain’s blood vessels can grow over time and eventually break, causing a life-threatening hemorrage.
The greatest danger of aneurysms is rupture. Approximately 50-75% of stricken people survive an aneurysmal rupture.
If you have two or more relatives with a brain aneurysm or certain disorders that affects your connective tissue, like polycystic kidney disease are major risk factors. Smoking, obesity, drug or alcohol abuse and high blood pressure can also be a major risk factor.
Brain aneurysms are due to weakness in the wall of a blood vessel within the brain. When the wall of the vessel gets weak and deteriorates, blood flow pressure will cause a rupture that causes blood to leak into the tissue around the brain.
Researchers from TLCF says that 9% of Americans in US are living with an un-ruptured aneurysm. If the aneurysm does not rupture, many will never quess it’s existence.
About 25,000 people suffer a SAH each year. It is estimated that people with unruptured aneurysm have an annual 1-2% risk of hemorrhage. Under age 40, more men experience SAH. After age 40, more women than men are affected.
Most people who have suffered a SAH from a ruptured aneurysm did not know that the aneurysm even existed. Based on autopsy studies, medical researchers estimate that 1-5% of the population has some type of cerebral aneurysm. Aneurysms rarely occur in the very young or the very old; about 60% of aneurysms are diagnosed in people between ages 40 and 65.
If an aneurysm has not ruptured and is not causing any symptoms, it may be left untreated. Because there is a 1-2% chance of rupture per year, the cumulative risk over a number of years may justify surgical treatment. However, if the aneurysm is small or in a place that would be difficult to reach, or if the person who has the aneurysm is in poor health, the surgical treatment may be a greater risk than the aneurysm. Risk of rupture is higher for people who have more than one aneurysm. Unruptured aneurysm would probably be treated with a surgical procedure called the clip ligation.
Some studies seem to show that first-degree relatives of people who suffered aneurysmal SAH are more likely to have aneurysms themselves. These studies reported that such immediate family members were four times more likely to have aneurysms than the general population. Other studies do not confirm these findings. Better evidence links aneurysms to certain rare diseases of the connective tissue. These diseases include Marfan syndrome, pseudoxanthoma elasticum, Ehlers-Danlos syndrome, and fibromuscular dysplasia. Polycystic kidney disease is also associated with cerebral aneurysms.
These diseases are also associated with an increased risk of aneurysmal rupture. Certain other conditions raise the risk of rupture, too. Most aneurysms that rupture are a half-inch or larger in diameter. Size is not the only factor, however, because smaller aneurysms also rupture. Cigarette smoking, excessive alcohol consumption, and recreational drug use (for example, use of cocaine ) have been linked with an increased risk. The role, if any, of high blood pressure has not been determined. Some studies have implicated high blood pressure in aneurysm formation and rupture, but people with normal blood pressure also experience aneurysms and SAHs. High blood pressure may be a risk factor but not the most important one. Pregnancy, labor, and delivery also seem to increase the possibility that an aneurysm might rupture, but not all doctors agree. Physical exertion and use of oral contraceptives are not suspected causes for aneurysmal rupture.
Causes and symptoms
Cerebral aneurysms can be caused by brain trauma, infection, hardening of the arteries (athero-sclerosis ), or abnormal rapid cell growth (neoplastic disease), but most seem to arise from a congenital, or developmental, defect. These congenital aneurysms occur more frequently in women. Whatever the cause may be, the inner wall of the blood vessel is abnormally thin and the pressure of the blood flow causes an aneurysm to form.
Most aneurysms go unnoticed until they rupture. However, 10-15% of unruptured cerebral aneurysms are found because of their size or their location.
Some aneurysms bleed occasionally without rupturing. Symptoms of such an aneurysm develop gradually. The symptoms include headache, nausea, vomiting, neck pain, black-outs, ringing in the ears, dizziness, or seeing spots.
Eighty to ninety percent of aneurysms are not diagnosed until after they have ruptured. Rupture is not always a sudden event. Nearly 50% of patients who have aneurysmal SAHs also experience “the warning leak phenomenon.” Persons with warning leak symptoms have sudden, atypical headaches that occur days or weeks before the actual rupture. These headaches are referred to as sentinel headaches. Nausea, vomiting, and dizziness may accompany sentinel headaches. Unfortunately, these symptoms can be confused with tension headaches or migraines, and treatment can be delayed until rupture occurs.
ANGIOGRAMS OF BRAIN ANEURYSM :
When an aneurysm ruptures, most victims experience a sudden, extremely severe headache. This headache is typically described as the worst headache of the victim’s life. Nausea and vomiting commonly accompany the headache. The person may experience a short loss of consciousness or prolonged coma. Other common signs of a SAH include a stiff neck, fever, and a sensitivity to light. About 25% of victims experience neurological problems linked to specific areas of the brain, swelling of the brain due to fluid accumulation (hydrocephalus ), or seizure.
Based on the clinical symptoms, a doctor will run several tests to confirm an aneurysm or an SAH. A computed tomography scan (CT) of the head is the initial procedure. A magnetic resonance imaging test (MRI) may be done instead of a CT scan. MRI, however, is not as sensitive as CT for detecting subarachnoid blood. A CT scan can determine whether there has been a hemorrhage and can assist in pinpointing the location of the aneurysm. The scan is most useful when it is done within 72 hours of the rupture. Later scans may miss the signs of hemorrhage.
If the CT scan is negative for a hemorrhage or provides an unclear diagnosis, the doctor will order a cerebrospinal fluid (CSF) analysis, also called a lumbar puncture. In this procedure, a small amount of cerebrospinal fluid is removed from the lower back and examined for traces of blood and blood-breakdown products. If this test is positive, cerebral angiography is used to map the brain’s blood vessels and the damaged area. The angiography is done to pinpoint the aneurysm’s location. About 15% of people who experience SAH have more than one aneurysm. For this reason, angiography should include both the common carotid artery that feeds the front of the brain and the vertebral artery that feeds the base of the brain. Occasionally, the angiography fails to find the aneurysm and must be repeated. If seizures occur, electroencephalography (EEG)may be used to measure the electrical activity of the brain.
The primary treatment for a ruptured aneurysm involves stabilizing the victim’s condition, treating the immediate symptoms, and promptly assessing further treatment options, especially surgical procedures. The patient may require mechanical ventilation, oxygen, and fluids. Medications may be given to prevent major secondary complications such as seizures, rebleeding, and vasospasm (narrowing of the affected blood vessel). Vasospasm decreases blood flow to the brain and causes the death of nerve cells. A drug such as nimodipine (Nimotop) may help prevent vasospasm by relaxing the smooth muscle tissue of the arteries. Even with treatment, however, vasospasm may cause stroke or death.
To prevent further hemorrhage from the aneurysm, it must be removed from circulation. In general, surgical procedures should be performed as soon as possible to prevent rebleeding. The chances that aneurysm will rebleed are greatest in the first 24 hours, and vasospasm usually does not occur until 72 hours or more after rupture. If the patient is in poor condition or if there is vasospasm or other complication, surgical procedures may be delayed. The preferred surgical method is a clip ligation in which a clip is placed around the base of the aneurysm to block it off from circulation. Surgical coating, wrapping, or trapping of the aneurysm may also be performed. These procedures do not completely remove the aneurysm from circulation, however, and there is some risk that it may rebleed in the future. Newer techniques that look promising include balloon embolization, a procedure that blocks the aneurysm with an inflatable membrane introduced by means of a catheter inserted through the artery.
Primary Signs of Aneurysm
- A severe blinding headache behind the eyes.
- Tingling sensation in the face and neck.
- Light sensitivity.
- Neck stiffness.
- Extreme fatigue.
- Weakness in the limbs.
- Blurred vision.
- Rarely patients have said there was a sensation of being “hit by lightening” or a loud boom as the aneurysm ruptures.
**** IF YOU HAVE ANY OF THESE SYMPTOMS WITH IN A FEW DAYS AFTER CHILDBIRTH DO NOT HESITATE CALLING 911 AND GET TO THE HOSPITAL , IMMEDIATELY !!
When the rupture happens, even a tiny leak will cause tremendous blood pressure within the brain. When this happens , blood flow will be cut off to vital areas and usually cause unconsciousness.
A Subarachnoid Hemorrhage (SAH), is fatal in 10-20% of patients before they reach the hospital. A ruptured aneurysm is fatal for 40-50% of patients within 30 days after the rupture, according to The Society of Neurointerventional Surgery.
IF YOU OR A LOVED ONE HAS ANY OF THE SYMPTOMS MENTIONED ABOVE, DO NOT HESITATE IN CALLING 911 FOR AMBULANCE, IMMEDIATELY!!
TIME IS LIFE IN THIS SITUATION!!