Subarachnoid Haemorrhage : A Double Whammy
What Doesn't Kill You Makes You Stronger
INTRODUCTION
Hi and thanks for visiting my site. I hope you will enjoy reading and having a look around. I will be adding to my site regularly but there is a lot to add, so please bear with me. Do pop back from time to time to see what's new.
For those of you not familiar with the term subarachnoid brain haemorrhage, I will give a little insight into what it is. I will share my story of surviving a subarachnoid haemorrhage in Turkey and sadly losing my mum to a subarachnoid haemorrhage back in 1990. Hence the title...A Double whammy!
One thing myself and family have found, is medical professionals are not forthcoming with information and often questions and fears go unanswered. I hope this site may help others find the answers they are looking for and by sharing mine and my mums story, I hope people will be more aware of this life threatening condition and the effects of suffering a subarachnoid haemorrhage can have.
If you like the site or find it helpful, please feel free to send to your family and friends via the share button at the bottom of the page. Or pass on the website address. Strokes can affect anyone of any age with no barriers of who is affected. Knowledge is power and one day it might just save your life, or that of someone you love.
DIFFERENT STROKES
There are two different forms of stroke. Haemorrhagic and thrombotic. Diagram 1. shows how a haemorrhagic stroke occurs when a blood vessel ruptures within the brain. Diagram 11. shows how a thrombotic stroke occurs when a blood clot blocks a cerebral artery.
This site, concentrates mainly on the haemorrhagic type. All information given on this site, is intended for guidance and advice only and should in no way replace the advice or care of a qualified medical professional.
SUBARACHNOID HAEMORRHAGE : THE FACTS
A subarachnoid haemorrhage occurs when there is a sudden leak of blood that enters the subarachnoid space. This is the area between the arachnoid membrane and the pia mater, which surrounds the brain. During a subarachnoid haemorrhage, the escaped blood irritates the brain and damages the brain tissue. A subarachnoid haemorrhage is a medical emergency, as quite often it is fatal.
Approximately 30% of patients will die before reaching the hospital and a further 30% will succumb within the next month. The remaining 40% that survive, often do so with disabilities. Only a lucky few experience survival without any impairment. The best outcomes are achieved in patients who receive immediate medical attention in specialist stroke patient facilities.
Symptoms of a subarachnoid haemorrhage vary from patient to patient, depending on the size and location of bleed. The classic symptoms to look for are, a sudden thunderclap headache often described as "the worst headache of their life", slurred speech, vomiting, photophobia, stiff neck/back and possibly partial or total loss of consciousness. A small percentage may also suffer a seizure.
Whilst most subarachnoid haemorrhages happen without warning, a number of patients experience warning signs leading up to the event. The signs can include headaches, dizzy spells, episodes of confusion, problems with balance and memory, word finding difficulties, and changes of emotional state. This list is a general guide as all patients symptoms vary. The symptoms are due to small leaks from the affected vessel, and are known as sentinel leaks. These symptoms should not be ignored and medical attention should be sought immediately.
A subarachnoid haemorrhage is a haemorrhagic stroke and accounts for up to 10% of all strokes. It is quite rare, however each year between 7000 and 8000 people in the UK will have a subarachnoid haemorrhage.
The most common cause of a subarachnoid haemorrhage is from an arteriovenous malformation (AVM) that bleeds or a ruptured brain aneurysm. These account for 80% of all subarachnoid haemorrhages. That is made up of 2% from bleeding AVM's and 78% from ruptured brain aneurysms. A further 10/15% are caused from sustained head injuries and in a small percentage, no cause is found. Only AVM and aneurysmal subarachnoid haemorrhage carries a high mortality rate which is why rapid diagnosis is essential.
An arteriovenous malformation is a collection of blood vessels within the brain that are entangled forming abnormal connections. The abnormal formation is a weak spot that is prone to bleeding.
A brain aneurysm is an abnormal widening or ballooning of the arteries or veins within the brain itself. The three types of aneurysm are fusiform, saccular and berry. A fusiform aneurysm is one without a stem. A saccular aneurysm is one with a saccular outpouching and is the most common type. A berry aneurysm has a neck and stem, resembles a berry in appearance and is most often genetic. Up to 15% of patients who have a berry aneurysm, will have multiple aneurysms.
Aneurysms may result from congenital birth defects or from pre-existing conditions such as high blood pressure and atherosclerosis. Others can be caused by infection and are known as mycotic aneurysms.
Subarachnoid haemorrhage has a tendency to run in families and if two or more direct relatives are affected, screening is recommended. The best methods of screening are CT angiography or MRI/A. However it is possible for MRI/A to miss aneurysms less than 7mm in size.
Certain heritable disorders can increase the risk of suffering a subarachnoid haemorrhage. These conditions are Polycystic Kidney Disease, Marfan Syndrome, Neurofibromatosis and Ehlers Danos Syndrome...particularly the vascular type. It is also worth noting that certain ethnic groups, carry a higher risk of developing brain aneurysms, particularly African, Japanese and Mexican descent.
Subarachnoid haemorrhage can occur at any age, but happens more frequently in the adult population. Sadly, even babies and young children can suffer a subarachnoid haemorrhage, although this is extremely rare. The average age of patients with subarachnoid haemorrhage is much lower than with other forms of stroke and women have a greater chance of suffering a subarachnoid haemorrhage than men, with a ratio of 2:1.
Around 100 people in 10,000 in the UK, go around their daily business, unaware that they have potentially fatal flaws in the blood vessels of their brains...SCARY!
Face...Check the patients face. Has it drooped on one side? Or has an eyelid closed over their eye?
Arms...Ask the patient to raise both arms above their head. Can they do this? Can they hold them there?
Speech...Is the patients speech slurred or slow? Ask the patient to repeat a simple sentence. Can they do this?
Time...If any of the above have occurred, it is time to call an ambulance.
In addition to the above stroke checklist, another sign to look for is a crooked tongue. Ask the patient to poke out their tongue and if it flops to one side or the other, or they cannot even manage to poke out their tongue, this is a sure sign that a stroke has occurred. Call an ambulance immediately and explain the urgency of immediate attention.
1) Avoid drinking alcohol to excess or in binges.
2) Do not smoke.
3) Take regular excercise.
4) Eat a healthy diet (mediterranean recommended).
5) Keep check on cholesterol levels.
6) Keep high blood pressure under control.
REPAIRING BRAIN ANEURYSMS
Surgery to any part of the brain is risky, but death is almost certain if the patient is left untreated. Repair of the ruptured area is vital to avoid re-bleeding. This happens most frequently within 24 hours of the initial bleed and carries added risks of more severe complications including death if the initial haemorrhage is survived. The risk increases all the while the patient is left without medical intervention. Risks involved with surgery include epilepsy, infection, a further stroke and in the worst case death.
There are currently two methods of repair for brain aneurysms. Clipping via craniotomy and endovascular coiling. Clipping via craniotomy is the good old fashioned way and endovascular coiling the more modern, less invasive approach. Both methods are suitable for ruptured and unruptured aneurysms. The choice of method used is usually based on size and location of aneurysm, patients physical health, age and expected prognosis.
Clipping via craniotomy was invented by American neurosurgeon, Walter Dandy in 1937. Craniotomy involves a skilled neurosurgeon, making an incision in the scalp and lifting the flap of skin to reveal the skull below. The surgeon will then drill a hole in the skull bone in order to reach the blood vessels beneath. Once the blood vessels are reached the surgeon can then strategically place a clip over the aneurysm, thus completely obliterating it from the blood supply.
Guido Guglielmi, an Italian neurosurgeon and radiologist, first invented the platinum coil in the late eighties. In 1991 the first endovascular coiling procedure was carried out at UCLA hospital in the USA. The method which is performed by an interventional radiologist, is now the preferred method for treating brain aneurysms due to being less invasive and yielding far quicker recovery times.
A small incision is made in the groin to gain access to the femoral artery. A catheter is then inserted into the artery and fed up to the brain via the aorta. Once in place, tiny coils are fed up through the catheter and are packed into the aneurysm itself. The coils prevent blood re-entering the aneurysm thus preventing further haemorrhaging.
The International Subarachnoid Haemorrhage Trials also indicate a lower morbidity rate and far higher chance of independent living when coiling is used. However more long term follow up care is required after this procedure than with surgical clipping and long term durability, is yet to be established in this relatively new technique.
RECOVERING FROM A SUBARACHNOID HAEMORRHAGE
Just as every subarachnoid haemorrhage is different, so is every recovery. To some extent, your recovery will depend on the damage done and that will depend on the location and severity of your bleed. What ever challenges you face, it is important to remember, your body has been through a severe trauma and recovery happens over time. There is no set time limit for "when" you will feel better but there is always scope for improvement, up to and beyond two years after your haemorrhage. The common symptom that virtually every survivor mentions is extreme fatigue. It is important to listen to your body and avoid exerting yourself too soon. However light exercise is recommended, as soon as you feel able. You may notice a reduction in your stamina and strength but this will improve in time. Some people are able to return to work in three to six months, carrying out less hours and lighter duties, whilst others take much longer and some retire never to return. Should you need to enquire about financial assistance while you are unable to work you should make contact with the Department for Work and Pensions.
Headaches will remain severe and frequent initially, this is due to the blood which has irritated the lining of the brain. This is reabsorbed natrually into the body, but can take some weeks to do so. After this process headaches should reduce in severity and frequency. Painkillers can be taken as needed.
Cognitive functions such as concentration, memory and decision making can all be affected after suffering a subarachnoid haemorrhage. Some people will also notice difficulty in learning new skills or absorbing new information. You may notice you can only concentrate for short periods of time and that you are more easily distracted than before. It is best to try not to do too many things at once and just concentrate on one thing or task. Memory impairment can be mild or severe, temporary or permanent. Those who suffer memory impairment, tend to suffer impaired short term memory whilst long term memory remains in tact.
Some people experience difficulty finding the right words and this can be worsened by tiredness. Others find their speech is slurred or slow. In most cases this improves with time, but if it persists the patient may wish to explore the option of speech therapy.
Occasionally people find they have weakness in one or more limb. To what extent varies greatly and limb strength improves with time and exercise. Severely affected people may wish to consider physiotherapy.
Emotions are easily changeable in recovery and you may feel vulnerable or weepy for no apparent reason. You may notice mood swings and feelings of despair. This is completely normal, and is the body's way of coping with the upheaval and changes it has been through. You will have good days and bad days, high points and low points. Emotional support is vital but also the time and space to return to an independant lifestyle. You may find it useful to attend a support group, where you can exchange thoughts and speak with others who have been through a similar experience.
It is a legal requirement for everyone who drives and has suffered a subarachnoid haemorrhage to inform the Driver Vehicle Licensing Agency (DVLA) when they intend to drive again. Failure to do so may result in a fine and withdrawal of your licence. You also need to inform your insurance company and if you continue to drive without doing so, may find your insurance policy is void.
Driver Vehicle Licensing Agency
After a subarachnoid haemorrhage, it is adviseable to wait a short time before flying. Normally between one and three months, depending on the severity of the bleed. When taking out travel insurance, you have a duty to inform the insurance company of your haemorrhage and will normally pay an excess on your policy. After two years you should no longer have to pay extra in relation to your subarachnoid haemorrhage if you are symptom free without any further problems or complications. Always make sure you take out a policy adequate for your needs, declaring any pre- existing conditions and it is essential to make sure repatriation is included.
Sex and pregnancy are two other common worries people have after suffering a subarachnoid haemorrhage. People who have sufferred the actual haemorrhage itself, during intercourse or pregnancy will of course be even more nervous and show elevated concern. Approximately 4% of people who have suffered a subarachnoid haemorrhage do so during or soon after intercourse. Once you are fully recovered and feel well enough, it is perfectly ok to resume a healthy sex life. Most female patients are advised to wait one year, before planning to become pregnant. This allows time for thorough healing from surgery. The risk of a repaired aneurysm rupturing due to having sex or being pregnant is almost negligible. Females who have an AVM need to be assessed individually as pregnancy can be a little more complicated and have added risks.
THE HUMAN BRAIN
The human brain is divided into three main parts, the cerebellum, the cerebrum and the brain stem. Each region controls specific functions. Arteries, capillaries and viens supply the brain with oxygen and nourishment and take away waste matter. If brain cells are deprived of oxygen for longer than three to five minutes they will begin to die. The human brain has done the majority of its growing by the time a child reaches the age of six. |
The human brain weighs around 3lbs, which is roughly 2% of total body weight, yet uses 20% of your body's energy. Mens brains are slightly larger than womens, but this has no bearing on intelligence. The human brain contains around 100 billion neurons responsible for every thought, movement or action you carry out. The human brain is the most complex brain of all animals on earth.
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DONATIONS AND CHARITY
I have been asked if I accepted donations, I do not except donations of any kind. If you wish to give to charity, please support your local stroke and cancer facilities, whatever country you may be in. They struggle for resources and every little really does help. Remember it does not have to be financial, time you can spare is just as valuable.
National Centre For Volunteering (UK)
