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Subarachnoid Hemorrhage
When a brain aneurysm ruptures, it causes bleeding into the compartment surrounding the brain, the subarachnoid space, causing a subarachnoid hemorrhage (SAH). Often the aneurysm heals over, bleeding stops, and the person survives. In more serious cases, the bleeding may cause brain damage with paralysis or coma. In the most severe cases the bleeding leads to death.
Statistics
50% of those people die within minutes of a massive hemorrhage. Of the 50% who survive, half will suffer delayed death. The remaining survivors, depending upon the level of hemorrhage, usually live with severe long-term deficits.
Once a hemorrhage has occurred, several consequences might develop.
What Happens to the Brain When an Aneurysm Bleeds?
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In most cases, after a rupture the bleeding quickly stops. However, if leaked blood touches brain cells, these cells may become damaged. Blood in the cerebrospinal fluid (CSF) increases the pressure on the brain.
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Damage to Brain Cells
Blood from an Aneurysm can leak into the CSF (cerebrospinal fluid) in the space around the brain (subarachnoid space). The pool of blood forms a clot. Blood can irritate, damage, or destroy nearby brain cells. This may cause problems with body functions or mental skills.
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Fluid Buildup in the Brain
Blood from a torn aneurysm can block CSF circulation. This can lead to fluid buildup and increased pressure on the brain. The open spaces in the brain, called ventricles, may enlarge. This is known as hydrocephalus. It can make a patient lethargic, confused, or incontinent. Fluid may also build up in the brain after surgery. To stop fluid buildup, a drain may be placed in the ventricles. This removes leaked blood and trapped CSF.
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Narrowing of Nearby Arteries
The blood sprayed around the base of the brain can also produce a problem called vasospasm. Vasospasm typically develops 5-8 days after the initial hemorrhage. Narrowing of the blood vessels can occur, and at times not enough blood is supplied to the brain and a stroke may result. To treat vasospasm, blood pressure is often elevated with medicines. Certain medications are also given to try to ease vasospasm. Finally, catheters can be introduced inside the artery in an attempt to use balloons or medications delivered to the vessel directly to open up these narrowed vessels. Vasospasm does relax over several days.
Hydrocephalus
Because blood is sprayed around the base of the brain, the possibility of fluid buildup exists, causing hydrocephalus. The fluid buildup on the brain is often treated with a tube inserted into the fluid-filled space of the brain (the ventricle). The tube is called a ventriculostomy, and often drains into a bag at the patient's bedside.
Vasospasm
The blood sprayed around the base of the brain can also produce a problem called vasospasm. The blood vessels narrow, and at times not enough blood can be supplied to the brain and a stroke may result. To treat vasospasm, blood pressure is often elevated with medicines. Certain medications are also given to try to ease vasospasm. Certain medications are given to ease the threat of vasospasm. This threat lessens over several days.
Treatment
The blood sprayed around the base of the brain can also produce a problem called vasospasm. The ruptured aneurysms can heal and be treated, depending upon the severity of the rupture, as well as other factors. Click on treatment to learn about the surgical and non-surgical procedures used to treat ruptured aneurysms.
Outlook
SAH survivors usually have a much longer recovery time than unruptured aneurysm patients, as well as more serious deficits. Symptoms are proportional to the degree of hemorrhage. Patients who are comatose or semi-comatose after a hemorrhage have longer recoveries and have more significant neurocognitive problems as compared to patients with smaller hemorrhages or unruptured aneurysms.
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