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.
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.