What is subarachnoid haemorrhage (SAH)?
Subarachnoid haemorrhage or SAH is the term used to describe bleeding into the subarachnoid space, between the membranes on the brain’s surface, which causes a stroke. The bleeding usually, but not always, follows the rupture of a cerebral aneurysm (a bulge in a weakened blood vessel).
Cerebral (brain) aneurysms can be completely symptomless until they rupture and bleed into the area around the brain. If a cerebral aneurysm is detected before it ruptures, for example, if the pressure on the brain causes the patient symptoms, such as impaired vision, pain around an eye or on one side of their face, or persistent headaches, surgery may be recommended to prevent the aneurysm from rupturing and causing an SAH.
As most cerebral aneurysms are symptomless and remain undetected until they rupture, SAH tends to occur without prior warning. Sometimes SAH occurs after the patient has engaged in activity involving physical effort or straining.
Am I at an increased risk of SAH?
If an individual is known to have a cerebral aneurysm then they have an increased risk of SAH and should receive medical advice about surgical treatment to reduce the risk of rupture.
Most people with cerebral aneurysms do not know that they have them. They are difficult to predict and are therefore difficult to prevent.
An individual’s risk of SAH might be increased by:
- high blood pressure
- drinking excessive amounts of alcohol
- if a family member has had an SAH
- certain other conditions, such as autosomal dominant polycystic kidney disease (ADPKD)
What causes SAH?
Ruptured cerebral (brain) aneurysm is a major cause of SAH.
Other, less common, causes of SAH include:
- abnormal development of blood vessels
- brain tumour (malignant or benign) causing damage to blood vessels
- brain infection, such as encephalitis
- other rare conditions which block or narrow the arteries of the brain
- vasculitis (inflammation of the brain’s blood vessels) e.g. from infection
What are the symptoms of SAH?
- a sudden, agonising headache with pain unlike anything the individual has experienced before, as if they have been hit on the head
- stiff neck
- photophobia (sensitivity to light)
- nausea and vomiting
- blurred or double vision
- stroke-like symptoms, such as slurred speech or weakness on one side of the body
- loss of consciousness or convulsions (fits)
What is the treatment for SAH?
Subarachnoid haemorrhage (SAH) is a medical emergency. If an individual is suspected to have suffered an SAH they need emergency admission to hospital where the diagnosis will be confirmed by a CT scan. If the CT scan does not confirm SAH but their symptoms cause their medical advisors to suspect SAH, they will undergo a lumbar puncture to check their cerebro-spinal fluid (CSF) for any evidence that there has been bleeding into the brain.
A patient who is thought to have SAH will be transferred to a hospital with cranial neurosurgery facilities. If the SAH was caused by a ruptured cerebral aneurysm, it will be surgically repaired to prevent further bleeding, either by a surgical procedure known as clipping, in which a craniotomy is performed and the blood vessel is clipped to prevent further bleeding, or by coiling, in which a catheter is inserted into a blood vessel in the patient’s leg or groin and platinum coils are fed into the aneurysm through the catheter. Clipping and coiling are both carried out under general anaesthetic.
The patient may also be given medication:
- to prevent brain damage after SAH from the reduced blood supply to the brain (secondary cerebral ischaemia)
- to prevent seizures (fits)
- to reduce sickness and vomiting
How common is SAH?
SAH is the cause of 5% of strokes in the UK. In England, approximately 6,000 people each year are admitted to hospital with SAH. It is most common between the ages of 45 and 75, occurs slightly more often in women than in men, but it can occur at any age.
Delay in medical treatment of SAH claims
Even with correct treatment, bleeding from a ruptured brain aneurysm can cause rapid and extensive damage to the brain. Half of all incidents of SAH end in fatality. In 30% of SAH cases, death occurs within 24 hours.
After SAH occurs, any delay in admission to hospital and surgical treatment increases the already high risk of severe brain damage and disability or death.
The recommended diagnosis-to-surgical treatment deadline (a recommendation from the 2013 National Confidential Enquiry into Patient Outcome and Death (NCEPOD)) for bleeding brain aneurysms is 48 hours but (according to the GIRFT Cranial Neurosurgery team’s report 2018 ) that treatment target is not met in about 10% of SAH patients.
What are the effects of brain injury from SAH?
A ruptured blood vessel and SAH causes damage to the brain as the blood (and oxygen) supply is reduced and pressure on the brain is increased by the bleeding into the subarachnoid space.
After the initial haemorrhage, the patient with SAH remains at risk of further complications:
- The healed aneurysm can rupture again. This is known as rebleeding and carries a high risk of permanent disability or death. Rebleeding can be prevented by surgical repair of the aneurysm immediately after the first SAH takes place.
- The patient’s brain can be damaged by cerebral ischaemia (lack of oxygen) arising from the blood vessels narrowing in spasm (vasospasm) which reduces the blood supply to the brain. This causes increasing drowsiness and coma. The SAH patient’s risk of secondary cerebral ischaemia is reduced by taking medication after the SAH.
- Hydrocephalus is a build-up of fluid on the brain which causes brain damage from increased intra-cranial pressure. Symptoms of hydrocephalus include headaches, vomiting, blurred vision and impaired walking ability. Hydrocephalus often occurs after SAH disrupts the production and drainage of cerebro-spinal fluid (CSF). It is treated by lumbar puncture or the temporary insertion of a shunt to drain excess fluid from the brain.
Longer term effects of brain injury from SAH depend on the severity of the SAH and its location inside the brain but can include:
- cognitive dysfunction (problems with memory, planning and concentration, affecting day to day tasks)headaches
- extreme tiredness
- sleep problems
- weakness and loss of sensation in arms and legs
- difficulty distinguishing between hot and cold, (with consequent safety issues around showering etc)
- impairment of sense of smell and taste
- visual impairment, (e.g. blurred or double vision, blind spots or black spots)
- difficulty understanding speech
- emotional and psychological problems, (anywhere from depression to PTSD)
How can Boyes Turner help?
Our medical negligence team are highly experienced in securing compensation for brain injured and severely disabled clients whose disability arose, wholly or in part, from negligent delays in their medical treatment.
Brain injury cases arising from SAH are complex and are often defended on the basis that even with prompt treatment the patient would have suffered some brain damage from the bleeding into the brain. These claims require expert specialist handling by brain injury specialists.
Where our client’s surgical treatment for SAH has been negligently delayed, causing additional severe brain injury and consequent disability, our experienced specialist brain injury lawyers work hard to make sure that the full extent of our client’s additional injury and disability and its impact on their life is properly assessed, rehabilitated early , and appropriately compensated.
We work closely with our trusted medical experts to investigate whether the care that our client received from ambulance, A&E and neurosurgical teams met acceptable standards for this life-threatening condition, and whether previous opportunities to identify and minimise our client’s risk of SAH from cerebral aneurysm rupture were acted upon by their doctors.
With liability established, we apply for early interim payments to facilitate early intervention and rehabilitation and therapies, and to meet the costs of necessary care, home adaptations and specialist equipment. Interim payments can also alleviate the financial hardship that is suffered when our client is unable to return to work following a brain injury.
We assess the extent and lifelong impact of the brain injury and loss of function and the compensation required to meet our client’s needs with the help of experts in a variety of disciplines. These depend on the circumstances of each individual’s case but often include care and case managers, physiotherapists, occupational therapists, speech and language therapists and psychologists.
We ensure that our clients’ damages settlements are structured to provide them with security and flexibility using lump sum and index-linked annual payments (PPOs) according to their needs.
Where negligent delays in the treatment of a patient with SAH has caused their death, we help the deceased’s dependents claim compensation for their loss.
To speak to a member of our experienced brain injury claims team please get in touch at firstname.lastname@example.org .