The intricate network of blood vessels in our brain supplies blood to it. These blood vessels branch into two sections. As blood flows, increased pressure is exerted on these branching points, making them weaker. When the pressure rises, these weak areas can bulge, forming what is known as an aneurysm. If the pressure continues to increase, the aneurysm may rupture. When it bursts, blood leaks out and spreads into the membrane covering the brain, a condition known as a subarachnoid hemorrhage. Immediate specialized medical treatment is necessary in such cases.

What Are the Symptoms?

A sudden, severe headache is the most important symptom of this condition. Sometimes, patients may experience a mild headache before the bleeding occurs, which later becomes intense. Other symptoms include:

  • Neck pain
  • Numbness in the body
  • Shoulder pain
  • Sensitivity to light
  • Blurred or reduced vision
  • Nausea and vomiting
  • Seizures
  • Confusion and disoriented behavior

The symptoms of a subarachnoid hemorrhage appear suddenly, and the patient may lose consciousness rapidly.

Who Is at Risk?

Subarachnoid hemorrhage can occur spontaneously due to a ruptured blood vessel or as a result of head trauma. If it occurs spontaneously, it is often linked to a brain aneurysm, which is an abnormality in the brain’s arteries. When an aneurysm bursts, rapid bleeding occurs, leading to blood clot formation.

Women, especially those with high blood pressure, and individuals who smoke are at higher risk. In some cases, head injuries can also cause this condition. The use of blood-thinning medications may increase the risk. Athletes and laborers who are at a higher risk of head injuries are also more vulnerable.

Diagnosis

A CT scan of the head should be performed immediately for diagnosis. However, if the bleeding is minimal, it may not always be detected through a CT scan. In such cases, neurologists may perform a spinal fluid analysis by extracting cerebrospinal fluid to confirm the condition.

To diagnose an aneurysm, a CT scan or MRI with contrast dye is required. For further confirmation, a cerebral angiogram, known as Digital Subtraction Angiography (DSA), is performed.

Coil Embolization is a minimally invasive surgery considered a modern treatment for this condition. This procedure does not require any incisions. A catheter is inserted into the brain’s blood vessels through a cannula, and a special wire or coil is placed inside the aneurysm to stop the bleeding. This prevents the aneurysm from rupturing again. This procedure is available in the country and carries minimal risk.

Another treatment option is surgical clipping, where the aneurysm is located and clipped through an open surgery to prevent further bleeding.

— Professor Dr. M. S. Zahirul Haque Chowdhury
Head of Clinical Neurology, National Institute of Neurosciences & Hospital, Dhaka

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