Sub-arachnoid haemorrhage is a type of brain injury that involves a sudden leakage of blood from a ruptured artery in the brain. The leakage most often occurs into the sub-arachnoid space surrounding the brain and spinal cord. The cause is usually a brain aneurysm which is a weakness in a blood vessel wall combined with the pressure of the circulating blood. The higher the blood pressure the greater the risk of a burst in a weakened vessel. Smokers and people with high blood pressure are most at risk.
A sub-arachnoid haemorrhage is most common in older people but it occurs not infrequently in young people with an inherited aneurysm. Classically the bleed occurs during physical effort, such as coughing or straining on the toilet, when the pressure of blood in the brain is temporarily raised, but it can happen at any time.
It is rare for an aneurysm to be detected before it starts to leak. The initial symptom is usually a sudden, intense headache that lasts for more than an hour, often at the back of the head. Most people will describe it as the worst headache they have ever experienced.
A correct diagnosis is made easier if the headache is followed by other symptoms such as vomiting, collapse, loss of consciousness, blurred vision or an inability to bear bright light (photophobia). However, these symptoms generally occur only with a fairly major leak. A CT scan, and sometimes a lumbar puncture, are usually performed to confirm a diagnosis.
In about 50% of cases there is a small ‘warning’ leak before the serious rupture occurs resulting in a very bad headache but few other symptoms, and it is these cases that are most often missed. It is particularly important that a correct diagnosis is made at this stage because subsequent bleeds are usually more severe and frequently result in death or severe disability.
If a brain aneurysm is detected at an early stage, before a major leak occurs, it can often be successfully treated by neurosurgery with the application of clips to the affected vessel.
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