What is a Subarachnoid Hemorrhage (SAH)?
A subarachnoid hemorrhage, sometimes known as a ‘bleed on the brain’, occurs when bleeding occurs in the subarachnoid space. The subarachnoid space lies beneath a layer of one of the brain’s coverings known as the meninges. First aiders and first responders should be aware of subarachnoid hemorrhage as this is a life-threatening emergency condition.
The most common cause of a subarachnoid hemorrhage is the rupture of an aneurysm. An aneurysm occurs when the walls of blood vessels become weakened and the blood vessel dilates. Aneurysms are at risk of rupturing and bleeding. Risk factors for developing aneurysms in the brain include smoking and high blood pressure (hypertension). People with kidney problems, such as polycystic kidney disease, are also more prone to developing aneurysms.
What are the signs and symptoms of a subarachnoid hemorrhage?
The most common symptom of a subarachnoid hemorrhage is a sudden, severe headache. The patient may describe the headache as being the worst headache they’ve experienced. Some patients may describe the pain as like being hit over the head with a baseball bat.
Other signs and symptoms of a subarachnoid hemorrhage include:
- Reduced level of consciousness
- Photophobia (light sensitivity)
- Neck stiffness
- Arm or leg weakness
Unfortunately, large subarachnoid hemorrhages may cause the patient to become immediately unconscious or suffer a sudden cardiac arrest.
The following quote is a description of suffering a subarachnoid hemorrhage from the Game of Thrones actress Emilia Clarke:
“Basically I was in the gym, the most excruciating pain, like an elastic band just went, like, snap in my head….an enormous amount of pressure suddenly, and then very very very quickly, I realised I couldn’t stand and I couldn’t walk, and in that moment I knew I was being brain damaged.”– Emilia Clarke
What is the first aid treatment for a subarachnoid hemorrhage?
The main first aid treatment for a suspected subarachnoid hemorrhage is to recognize the condition and call for emergency medical help. These patients may require urgent surgery (neurosurgery) in order to stop the bleeding inside the brain.
As a first aider, there’s nothing you can do to stop the bleeding. Instead, monitor the patient until emergency medical help arrives. If the patient is unconscious or has a seizure then ensure the airway is open and clear. Monitor vital signs and provide reassurance until medical help arrives.