Bleeding in the brain - Complications of a subarachnoid haemorrhage

If you have a subarachnoid haemorrhage, there is also a risk of developing further problems.

Some of the main complications are described below.

Rebleeding

A potentially serious early complication of a subarachnoid haemorrhage is that the brain aneurysm bursts again after it has sealed itself. This is known as rebleeding.

The risk of rebleeding is highest in the few days after the first haemorrhage, and rebleeding carries a high risk of permanent disability or death. Because of this, aneurysm repair is needed as soon as possible.

For more information about surgical treatment, read about treating subarachnoid haemorrhages.

Delayed cerebral ischaemia

Delayed cerebral ischaemia, or vasospasm, is another serious and common complication of a subarachnoid haemorrhage. This is when the supply of blood to the brain becomes dangerously low, disrupting the normal functions of the brain and causing brain damage. It is most common a few days after the first haemorrhage.

The cause is uncertain, but vasospasm of the arteries inside the brain may be a factor. Vasospasm is when a blood vessel goes into a spasm, causing the vessel to narrow.

Common symptoms are increasing drowsiness, which can lead to a coma, with or without other stroke-like symptoms, such as weakness down one side of the body.

There are a many treatments that can be used to prevent and treat delayed cerebral iscahemia, including a medication called nimodipine. See treating subarachnoid haemorrhages for more information about nimodipine.

Hydrocephalus

Hydrocephalus is a build-up of fluid on the brain, which increases pressure and can cause brain damage.

This can cause a wide range of symptoms, including:

headache
being sick
blurred vision
difficulty walking

Hydrocephalus is common after subarachnoid haemorrhage, as the damage caused by a haemorrhage can disrupt the production and drainage of cerebrospinal fluid (CSF).This can lead to increased amounts of fluid around the brain.

CSF is a clear colourless fluid that supports and surrounds the brain and spinal cord. A constant supply of new CSF is produced inside the brain, while the old fluid is drained away into blood vessels.

Hydrocephalus may be treated with a lumbar puncture or a temporary tube that is surgically implanted into the brain to drain away the excess fluid.

Long-term complications

There are a number of long-term complications that can affect people after a subarachnoid haemorrhage. These are outlined below.

Epilepsy

Around 1 in 20 of people who have a subarachnoid haemorrhage develop epilepsy.

This is a condition where the normal working of the brain is interrupted, causing a person to have repeated fits or seizures.

There are different types of seizure, and symptoms vary. You may lose consciousness, have muscle contractions (your arms and legs twitch and jerk) or your body may shake or become stiff. Seizures usually last between a few seconds and several minutes, before brain activity returns to normal.

In most cases of epilepsy following a subarachnoid haemorrhage, the first seizure occurs in the year after the haemorrhage.

Epilepsy can be treated using anti-epileptic medicines, such as phenytoin or carbamazepine. A specialist called a neurologist will help decide which treatment you need and how long you need to take it for.

Cognitive dysfunction

Cognitive dysfunction is when a person experiences difficulties with one or more brain functions, such as memory.

Cognitive dysfunction is very common complication of a subarachnoid haemorrhage, affecting most people to a certain degree.

Cognitive dysfunction can take a number of forms, such as:

problems with memory – memories before the haemorrhage are normally not affected, but you may have problems remembering new information or facts
problems with tasks that require some degree of planning – you may find that even simple tasks, such as making a cup of tea, are difficult and frustrating
problems with concentration or attention

There are a number of self-care techniques you can use to compensate for any dysfunction. For example, breaking tasks down into smaller steps and using memory aids (such as notes or a diary) can help.

A specialist called an occupational therapist can also help make day-to-day activities easier, while a speech and language therapist can help with communication skills. The doctor in charge of your care can tell you how to access these types of services.

Most cognitive functions will improve with time, though problems with memory can be persistent.

Emotional problems

Emotional problems are another common, long-term complication of a subarachnoid haemorrhage.

These problems can take a number of forms, such as:

depression – feeling very down, hopeless and not getting any real enjoyment out of life
anxiety disorder – a constant sense of anxiety and dread that something terrible is going to happen
post-traumatic stress disorder (PTSD) – where a person often relives a previous traumatic event (in this case the haemorrhage) through nightmares and flashbacks, and they may experience feelings of isolation, irritability and guilt

These mood disorders can be treated using a combination of medication, such as antidepressants, and talking therapies, such as cognitive behavioural therapy (CBT).