My family member was diagnosed with a subarachnoid hemorrhage: What does it mean?
What a subarachnoid hemorrhage is, where the bleeding occurs, why it is not always caused by an aneurysm, how doctors look for the cause, and what to ask the care team.
By Dr. Martin Roberto Casas MartínezNov 7, 20265 min read
In this article
Summary: A subarachnoid hemorrhage is bleeding in the space around the brain, between the brain and the thin tissues that cover it. It is an emergency treated in the hospital. It may be caused by a ruptured aneurysm, a blow to the head, or other causes, so the care team performs tests to find its source.
If your family member has been diagnosed with a subarachnoid hemorrhage, you probably have many questions about what it means and what happens next. This article offers an initial explanation in plain language to help you better understand what the care team tells you and prepare your questions.
It does not provide a prognosis: the course depends on each case. If someone is experiencing a sudden, very severe headache right now, call 911.
Where exactly is the bleeding?
The bleeding is in the subarachnoid space, the area between the brain and the thin membranes surrounding it. This is a type of hemorrhagic stroke, different from bleeding within the brain tissue.
This space normally contains cerebrospinal fluid, the clear fluid that surrounds and protects the brain. According to MedlinePlus, the main symptom is usually a severe headache that starts suddenly, sometimes described as “the worst headache of your life.” Neck stiffness, vomiting, confusion, or decreased alertness may also occur.
Is it always caused by an aneurysm?
No. A ruptured aneurysm is one possible cause, but MedlinePlus mentions others, such as a head injury, an arteriovenous malformation, blood clotting disorders, or the use of anticoagulants. In some cases, the cause is not identified.
- •Brain aneurysm: a weak area in the wall of an artery that bulges and may rupture.
- •Arteriovenous malformation (AVM): an abnormal tangle of blood vessels that can bleed.
- •Head injury: bleeding caused by a blow; according to MedlinePlus, in older adults it is often due to falls.
Knowing the cause helps guide treatment, so finding it is one of the care team's first tasks.
How do doctors look for the cause of the bleeding?
A head CT scan is usually done first to confirm the bleeding. Then, blood vessel imaging tests, such as CT angiography or cerebral angiography, look for an aneurysm or another lesion that could explain the hemorrhage.
- •Lumbar puncture: collection of a small sample of fluid from the spine; it may be recommended if the CT scan does not show bleeding.
- •CT angiography: a CT scan with contrast dye that shows the arteries.
- •Cerebral angiography: a test using a catheter that provides detailed images of the blood vessels.
If an aneurysm is not found, MedlinePlus notes that close monitoring and repeat imaging tests may be needed.
What care is provided in the hospital?
The goals are to stabilize the person, treat the cause of the bleeding when it is identified, relieve symptoms, and prevent complications. For this reason, monitoring may take place in the intensive care unit.
If the cause is an aneurysm, it may be repaired with surgery (placing a clip) or from inside the artery with coils, depending on the case. The care team monitors for complications such as rebleeding, arterial spasm (narrowing that can reduce blood flow to the brain), and seizures.
If the person is critically ill, repair may be delayed until they are more stable, and in some cases a drain is placed to relieve pressure inside the head. If they are conscious, they may be advised to rest and avoid straining, such as bending over or bearing down.
What can the family do while waiting for more information?
You can help by sharing your family member's medical history and medications, choosing one person to receive and relay updates, and writing down your questions. It is normal for the care team to be unable to predict the course during the first few days.
MedlinePlus indicates that the prognosis depends on many factors, such as the location and amount of bleeding and any complications. For this reason, answers may change from one day to the next. Tell the care team if your family member takes blood thinners or if there is a family history of aneurysms. If the hospital offers social work or psychological support for families, ask how to access it.
Frequently asked questions
Is a subarachnoid hemorrhage the same as a stroke?
It is a type of hemorrhagic stroke, which some people colloquially call a stroke. It is different because the bleeding occurs in the space around the brain, not within the brain tissue.
Can it bleed again?
This is a complication the care team monitors closely, especially until the cause has been controlled. That’s why they look for the source of the bleeding and treat it when possible. Ask what measures they’re taking in your family member’s case.
Do other family members need to be tested?
It depends on the cause and your family history. If an aneurysm is confirmed, ask the care team whether your immediate family members should discuss it with their doctors; the decision to test them is made on an individual basis.
What should I ask the care team?
If someone has a sudden, very severe headache or another sudden neurological symptom, call 911 first. While your family member is in the hospital, these questions may help:
- •Do we know what caused the bleeding, or what tests are still needed to find out?
- •What complications are you monitoring for over the next few days, and how will you let us know if anything changes?
- •Who will update us, how often, and who can we direct our questions to?
To learn more about these topics during follow-up, you can read about ruptured and unruptured aneurysms and recovery after a rupture.
For non-urgent questions or to request an individual assessment, you can contact the office.
Informational notice: This content is for informational purposes and does not replace a medical consultation or constitute a diagnosis.
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