Bleeding in the brain - Treating subarachnoid haemorrhages

If you are diagnosed as having had a subarachnoid haemorrhage, or a diagnosis is strongly suspected, you will probably be transferred to a neurosciences unit.

These units have a range of equipment and treatments that can be used to support many of the body's vital functions, such as breathing, blood pressure and circulation.

In more severe cases, you may be transferred to an intensive care unit (ICU).

The treatments you may have are described below.

Medication

Nimodipine

One of the main complications of a subarachnoid haemorrhage is secondary cerebral ischaemia. This is where the supply of blood to the brain becomes dangerously reduced, disrupting the normal functions of the brain, causing brain damage.

You will usually be given a medication called nimodipine to reduce the chances of this happening. This is normally taken for three weeks, by which point the risk of secondary cerebral ischaemia has usually passed.

Side effects of nimodipine are uncommon, but can include flushing, feeling sick, increased heart rate, headaches and a rash.

Pain relief

Medication can be effective in relieving the severe headache pain associated with a subarachnoid haemorrhage.

Commonly used pain-relieving medications include morphine and a combination of codeine and paracetamol.

Other medications

Other medications that are sometimes used to treat people who have had a subarachnoid haemorrhage include:

• anticonvulsants, such as phenytoin, which may be used to prevent seizures (fits)
• antiemetics, such as promethazine, which can help stop you feeling sick and vomiting

Surgery and procedures

If scans have shown that the subarachnoid haemorrhage was caused by a brain aneurysm, a procedure to repair the affected blood vessel and prevent the aneurysm from bleeding again may be recommended.

This can be carried out using one of two main techniques. These are described below.

Neurosurgical clipping

Neurosurgical clipping is carried out under general anaesthetic, meaning you will be asleep throughout the operation. A cut is made in your scalp (or sometimes just above your eyebrow) and a small flap of bone removed, so the surgeon can access your brain.

When the aneurysm is located, the neurosurgeon (an expert in surgery of the brain and nervous system) will seal it shut using a tiny metal clip that stays permanently clamped on the aneurysm. After the bone flap has been replaced, the scalp is stitched together.

Over time, the blood vessel lining will heal along where the clip is placed, permanently sealing the aneurysm and preventing it from growing or rupturing again.

Endovascular coiling

Endovascular coiling is also usually carried out using general anaesthetic. The procedure involves inserting a thin tube called a catheter into an artery in your leg or groin. The tube is guided through the network of blood vessels into your head and into the aneurysm.

Tiny platinum coils are then passed through the tube and into the aneurysm. Once the aneurysm is full of coils, blood cannot enter it. This means the aneurysm is sealed off from the main artery, which prevents it from growing or rupturing again.

Coiling versus clipping

Whether clipping or coiling is used depends on things such as the size, location and shape of the aneurysm.

Coiling is often the preferred technique because it has a lower risk of short-term complications (such as seizures) than clipping, although the long-term benefits over clipping are uncertain.

People who have the coiling procedure usually leave hospital sooner than people who have the clipping procedure, and the overall recovery time can be shorter.

However, when these types of surgery are carried out as an emergency after a subarachnoid haemorrhage, your recovery time and hospital stay depend more on the rupture's severity than the type of surgery carried out.