Q: How are subarachnoid hemorrhages treated?
A: First, doctors will search for the source of the bleeding and, once it’s found, perform surgery to close off the ruptured aneurysm and prevent it from starting to bleed again.
If we can’t find an aneurysm, we wait five to seven days, and then we repeat the angiogram again. Sometimes if you wait a while you see a small aneurysm that might have been hidden before. If the angiogram still doesn’t find an aneurysm on the second try, we typically just chalk it up to a vein.
In the meantime, patients have to get through the aftereffects of bleeding in the brain. It generally takes a while to recover from this, and Mr. Michaels will have to go through all of it.
Q: What is the prognosis for this type of brain hemorrhage?
A: Thirty-five to 50% of patients will die after a subarachnoid hemorrhage, while about a quarter will end up with some kind of neurological deficit. This can range from a type of nerve damage that interferes with normal eye movement (oculomotor nerve palsy) to paralysis, and anything in between.
It really depends on how bad the bleeding was and where the aneurysm was located. Twenty-five to 40% of patients will recover completely with no neurological problems.
Q: What are some risk factors for hemorrhagic stroke?
A: High blood pressure, cigarette smoking, and having a close relative with a brain aneurysm are the main risk factors. The fact that Mr. Michaels has diabetes wouldn’t directly increase his risk, although people with diabetes are more likely to have hypertension.
Q: Is subarachnoid hemorrhage rare?
A: About 3% of the general population has an aneurysm. At our hospital, we probably see more than 500 aneurysm patients annually. It’s not rare, but having said that, only about 10% of those end up like Mr. Michaels, where we don’t find their aneurysm.
Q: Is there anything people can do to reduce their risk of brain hemorrhage?
A: People should keep their blood pressure and cholesterol levels under control and take antihypertensive medications if necessary, as well as cholesterol-lowering drugs if needed. If you smoke, quit.
If you have a family history of aneurysm, you can undergo a screening test to see if you have one as well; if you do, you and your doctor can decide whether you need surgery to repair it. A ruptured aneurysm must be treated within 24 hours. An aneurysm that isn’t ruptured isn’t an emergency, but should be addressed promptly.