What are the Symptoms?

The main symptom is a sudden headache, which is likely to be far more painful than an ordinary headache or even a migraine . A stiff neck and virtual inability to endure bright light (photophobia) often follow, and there may also be faintness, dizziness, confusion, drowsiness, nausea and vomiting. A major attack can cause sudden loss of consciousness.

What are the Risks?

Subarachnoid hemorrhage usually occurs in people aged 40 to 60 and is slightly more common in women. Anyone with high blood pressure or diabetes mellitus may be more susceptible.

Up to 45 per cent of major attacks (those that cause unconsciousness) are fatal, and one in three people who survive a first attack have additional attacks. There is a risk of permanent brain damage due to the pressure of blood on the brain surface. In many cases, either blood spreads into the brain tissue, causing stroke-like symptoms, or the blood vessels constrict, causing similar problems.

What should be Done?

If you get a sudden severe headache, especially if it is accompanied by a stiff neck and sensitivity to light, call a physician without delay. If someone in your presence complains of a sudden headache and then lapses into unconsciousness, two possible causes are stroke and subarachnoid hemorrhage. In either case, while waiting for a physician, follow the first-aid instructions given in Accidents and emergencies.

With an unconscious person the physician’s first step is to initiate life-saving procedures to restore circulation and breathing. Once the patient is out of danger, the next step is to determine the cause of the problem. If an examination suggests a subarachnoid hemorrhage, the best way to confirm the diagnosis is to do a lumbar puncture, a test that involves taking a specimen of cerebrospinal fluid. (The fluid in the subarachnoid space of both the brain and the spinal cord is the same.) The easiest place to take the specimen and check it for blood is in the lumbar region, at the base of the spine.

What is the Treatment?

If blood is found in your cerebrospinal fluid, your physician’s main concern will be to prevent further bleeding. No drug treatment can heal a burst artery, but if you survive the first few days after a subarachnoid hemorrhage, the rupture that caused the problem has probably been sealed (at least temporarily) by natural clotting of blood, and healing is under way. The basic treatment then is several weeks of bed test, usually in the hospital. One purpose of this rest is to prepare you for surgery, if it is necessary. (In some cases, surgery is done almost immediately.) During this period of rest, the doctor may prescribe a painkiller to relieve headaches. If your blood pressure is high, you will also have to take medication to reduce it.

Within three days of the attack, you will probably have special X-rays of the major arteries that supply your brain. These are called arteriograms. They are done to locate the site of an aneurysm or any other defective spots in arterial walls. If the arteriograms indicate a danger of later attacks, surgery to prevent more leakages may be advisable. The surgery involves sealing off an aneurysm by means of a tiny metal clip.

What are the Long-Term Prospects?

If you regain consciousness after a major attack and survive for six months without further problems, you are probably out of danger. Chances of full recovery from surgery, if it is advised, are also good. Residual damage from an attack varies according to what areas of the brain are affected. Partial paralysis, weakness, or numbness may linger or even be permanent, as may sight and speech difficulties (for further information, . You should have your blood pressure checked regularly, and high blood pressure controlled if possible.