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Your guide to subarachnoid haemorrhages

Man holding his head in pain - subarachnoid haemorrhages

A subarachnoid haemorrhage (SAH) is a serious, life-threatening condition that requires emergency admittance to a hospital’s Medical Assessment Unit and then a quick transfer to the care of the neurology team.

If SAH is not diagnosed and treatment is delayed, complications can arise and a patient’s condition can deteriorate rapidly with severe consequences.

The onset of a major brain haemorrhage can occur without warning and only half of all patients are affected by prior symptoms. A patient may arrive at A&E suffering from the rapid onset of a severe headache or they could be in a coma.

Doctors should be acutely aware of even the relatively minor symptoms

While diagnosis is not straightforward, doctors at a hospital’s A&E department should be acutely aware of even the relatively minor symptoms that sometimes occur, which may give an indication of SAH. A delay or failure to correctly and promptly identify and treat SAH can lead to avoidable disability or death.

While in some circumstances, a progressive recovery may be achieved, for many patients, the disability will be permanent. The effects of a brain injury can vary from headaches through to severe mental and physical incapacity. Patients may require lifelong care, support, treatment, specialist equipment and adapted accommodation.

Finding out whether there has been a delay in treatment or a misdiagnosis can often be a complex process. If you are considering bringing a medical negligence claim as a result of poor medical treatment, you need a specialist lawyer with proven expertise in medical negligence claims.

Sensitivity and understanding throughout

Understandably, medical negligence cases can be emotionally difficult and therefore demand the highest degree of sensitivity and understanding by lawyers throughout the claims process.

Our dedicated team of specialist solicitors have many years of experience in successfully resolving clinical negligence claims. We can help you find out why the system failed to provide the appropriate care at the right time and, crucially, obtain answers and compensation to ensure that your future financial needs arising because of the negligence are met.  These may include treatment, equipment, support and accommodation.

SAH statistics

  • 1 in every 20 strokes or around 8,000 people suffer from a SAH in the UK every year.                                                                                                                   (NHS UK)      
  •  SAH is the cause of about 6% of first strokes.                                      (Patient.co.uk)        
  • Over 11,000 people were admitted to hospitals in England with a SAH between April 2012 and April 2013.                                                                                 (NHS UK)                                                                                          
  • SAH is most common in people aged between 45 and 70, affecting slightly more women than men.                                                                                               (NHS UK)             
  • The average age for a SAH is 50 years - most patients are aged under 60 years.  (Patient.co.uk)

What is a subarachnoid haemorrhage (SAH)?

A subarachnoid haemorrhage is a type of stroke caused by sudden bleeding on the surface of the brain.

The brain is covered by layers of tissue linings or membranes.  A SAH occurs under one of these layers – known as the ‘arachnoid’ membrane - where the vessels supplying blood to the brain are located. They are also surrounded by cerebrospinal fluid (CSF), which protect the brain and spinal cord.

What causes a SAH?

In around three quarters of cases, a SAH is the result of a ‘brain aneurism’ – a balloon-like swelling caused by a weakness in the wall of one of the blood vessels supplying blood to the brain.

A haemorrhage occurs when, under pressure from blood being pumped through the brain, the wall of this aneurysm bursts and blood escapes into the surrounding brain tissue.

Subarachnoid bleeding is also commonly caused by a severe head injury, called a “traumatic SAH”.

Are there warning signs?

Rarely are there warning signs of the onset of a SAH.

While an aneurysm can press on a particular part of the brain and symptoms might develop as a result, aneurysms usually go undetected with no symptoms until they burst.

Symptoms of SAH

Sudden intense, severe headache - the main symptom of a SAH, often described as a blinding pain.

Other symptoms can include:

  • Nausea and vomiting (feeling and being sick)
  • Stiff neck
  • Slurred speech
  • Blurred or double vision
  • Sensitivity to light
  • Confusion
  • Physical problems
  • Weakness on one side of the body
  • Seizure/convulsions
  • Loss of consciousness

Who is at risk from SAH?

It is not fully understand why brain aneurysms develop in particular people but key risk factors are:

  • Smoking
  • High blood pressure
  • Excessive alcohol consumption
  • Family history of condition
  • Aged between 45 -70

Less common causes of SAH include:

  • Abnormally developed blood vessels
  • Inflammation of blood vessels in the brain

Aneurysms can and do occur in people without the above known risk factors and there is no reason why a haemorrhage occurs on one day rather than another.

The onset of a SAH may occur during physical effort, such as coughing, heavy lifting, straining or using the toilet.

What should happen in hospital?

At your local hospital, a haemorrhage should be confirmed by a CT scan of the brain. A sample of fluid should also be taken from the spine - a procedure known as a lumbar puncture.

Further tests should also be carried out, which could include an angiogram (an X-ray of the blood vessel), an MRI scan and/or an MRA scan (which is a MRI scan of the blood vessel).

Treating SAH

If a diagnosis of subarachnoid haemorrhage is confirmed or strongly suspected, normally the next vital step is to transfer the patient to a specialist neurosciences unit.

The aim of treatment is to prevent the condition worsening before it causes serious disability. Medication is usually given to help prevent short-term complications and surgery may be carried out to stem the source of the bleeding.

Possible complications

A subarachnoid haemorrhage can cause both short and long-term complications.

Serious short-term complications can include:

  • Further bleeding - at the site of the aneurysm
  • Brain damage - caused by a reduction in blood supply to the brain.

Long-term complications

Post-treatment, common problems can arise with extreme tiredness, headaches and sleeplessness. More serious problems can include:

  • Epilepsy – repeated seizures / fits
  • Mental functions - memory, planning and concentration, changes in mood.

How Your Legal Friend can help you...

If SAH is confirmed the long term prospects can be poor. It is crucial that a patient must be seen as quickly as possible by a specialist on a neurological team for a reasonable chance of recovery.

Clinical negligence cases involving brain injuries can often be caused by delays, failure or errors made by a doctor, specialist, surgeon or hospital care team.

Negligent treatment during surgery to repair a brain aneurism can also cause damage that would otherwise not have occurred.

As experienced clinical negligence specialists, we know that you and your family need to find out what went wrong and whether there was a delay or failure in treatment.  We are committed to ensuring you are able to fully make your case, find out why the system failed to provide the appropriate care at the right time and, crucially, obtain compensation to ensure that your future financial needs arising from the negligence are met.