What happens in hospital?
Once subarachnoid haemorrhage has been diagnosed, you will usually be transferred to the nearest neurological unit, where investigations are carried out to determine the cause of the bleed. These investigations may be delayed until your clinical condition has stabilised. The priority however, is to prevent further bleeding by careful management in the intensive care unit and treatment of the site of the bleed.
The primary means of investigation is a cerebral angiogram, a minimally invasive procedure which maps out the blood circulation in the brain by means of X-rays combined with computer technology. Once the cause of the bleed has been determined, the treatment to prevent further bleeding can be decided upon.
In the case of aneurysms, the preferred method of treatment is to fill the aneurysm with fine platinum coils which blocks it off from the circulation. This is called endovascular coiling and is an angiographic procedure which can be carried out immediately following the initial angiogram.
Not all aneurysms are suitable for coiling and these may need to be clipped from the outside by a neurosurgeon. This involves placing a small clip over the neck of the aneurysm to seal it off from the circulation. Arteriovenous Malformations (AVM) are usually removed by surgery. In some cases, no cause can be found for the bleed and the outcome for these patients is usually good.
Joan from London, SAH November 2006 says:
They took me down to surgery and I was down there for 4 to 5 hours after which they brought me back to the ward where I was again wired up to everything. I was very dozy and incoherent and they started the routine they were to repeat every 15 minutes - who I was, did I know where I was, did I know what day it was? Sometimes I knew who I was but that was about it. My speech was slurred and I struggled to get more than the odd phrase out. I kept asking what had happened to me, but I had no idea I was in hospital.
Karen (45) from Dorset, SAH July 2005 says:
The Nurses were great, but it all felt so surreal and I felt so weak and tired. I was given an angiogram and a MRI and was told that an aneurysm had ruptured on my right posterior communicating artery and it would need to be coiled. I'd also suffered third nerve damage to my right eye and that's why my eye remained shut. The Consultant mentioned that I probably wouldn't be allowed to drive for 6 months to a year.
The following day, I had my operation and I can remember asking the surgeon to please make sure that I was asleep before they started. The op went fine and the next day I was put onto a normal neuro ward I just drifted in and out of sleep, in-between bouts of severe head and back pain. I could barely hold a conversation when people came into visit and the fatigue was overwhelming. I was given a black pirates eye patch to put over my bad eye, as it had started to open and I had bad double vision, even so, I was still feeling so very grateful that I had survived.
Keith (46) from Hampshire, SAH August 2006 says:
I had no idea what had happened until I woke up 2 days later in the neurosciences intensive care unit. I was then told that I'd had a brain haemorrhage and it had been fixed by inserting platinum coils into the aneurysm. All the hospital staff were great, but the endless rounds of questions - "Do you know where you are?", "Who's the prime minister?" etc got me down a bit. I don't remember much of my time there and the whole hospital experience was a bit vague
Following treatment you will probably spend some time in intensive care before being transferred to the high dependency unit and finally to a neurological ward.
For the first 3 weeks following subarachnoid haemorrhage you will be given a drug called nimodipine to reduce the chance of the arteries in the brain constricting, a condition called vasospasm. The risk of vasospasm during the early days is closely monitored.