American Medical Association Family Medical Guide - American Medical Association [420]
If blood is found in the cerebrospinal fluid, the treatment of a subarachnoid hemorrhage will concentrate on preventing further bleeding. The doctor will order an angiogram (see page 110), an X-ray examination of the arteries that supply blood to the brain, to locate the source of the bleeding and to look for an aneurysm. If an aneurysm is detected, surgery will be performed in which the doctor places a tiny clip across the neck of the aneurysm, blocking blood flow to that part of the artery. In some cases, an aneurysm can be sealed from the inside by passing a small coil or balloon through the arteries to the site of the aneurysm. The coil or balloon is released from the tip of the catheter to obstruct the opening of the aneurysm, blocking blood flow to the area and reducing pressure on the damaged artery wall. The person may be given medication orally or intravenously (through a vein) to prevent spasms of the blood vessels.
WARNING!
Signs of a Subarachnoid Hemorrhage
If you develop a sudden, severe headache accompanied by neck stiffness or pain, go to a hospital emergency department immediately. If someone complains of a sudden headache and then lapses into unconsciousness, call 911 or your local emergency number or take the person to the nearest hospital emergency department immediately. While waiting for help, follow the first-aid instructions on page 159, which include checking the person’s airway, loosening tight clothing around his or her neck and chest, and placing him or her in the recovery position.
If an aneurysm is not detected and a person survives after a subarachnoid hemorrhage without further problems, chances for a full recovery are good. Until the person is out of danger, the doctor will recommend complete bed rest to keep blood pressure down. He or she may prescribe medication to promote relaxation, prevent seizures, and reduce narrowing or spasms of the blood vessels. If the person’s blood pressure is very high, the doctor may prescribe antihypertensive medication.
Subdural Hemorrhage and Hematoma
In subdural hemorrhage, blood leaks from blood vessels in the dura mater, the outermost of the three membranes that cover the brain. The ruptured blood vessels are usually small veins that break on the underside of the dura mater. Because blood pressure in veins is less than that in arteries, blood tends to seep slowly into the space between the dura mater and the arachnoid (the middle of the three membranes) and causes a hematoma (a collection of clotted blood). Subdural hemorrhage usually results from a head injury (see page 680), most often in older people who have fallen or bumped their head; the veins stretch and tear upon impact.
Symptoms
The symptoms of subdural hemorrhage develop gradually over a period of hours or, sometimes, days. Symptoms can include drowsiness, confusion, weakness or numbness on one side of the body, loss of balance and coordination, or persistent or recurring headaches and nausea. Initially the symptoms may come and go, but eventually they become persistent.
Diagnosis
A diagnosis of subdural hemorrhage and hematoma is made from the symptoms, a physical examination, and the results of a CT scan (see page 112) or MRI (see page 113).
Treatment
The treatment of subdural hemorrhage depends on the size of the hematoma and may include surgery to remove the clot. If the clot is small, surgery may not be necessary because the blood clot will gradually be reabsorbed by the body. The doctor will closely monitor the person’s condition, and may recommend rehabilitation therapy (see page 672) to help him or her recover any lost function.
Subdural hematoma
A subdural hemorrhage is bleeding between the dura mater and the arachnoid, two of the three membranes covering the brain. A subdural hematoma results when the blood collects there and clots. In addition to compressing brain tissue, the hematoma can cause shrinkage of the ventricle (one of four cavities in the brain that produce cerebrospinal fluid) on that side of the brain. The symptoms of a subdural hematoma