Traumatic Subarachnoid Hemorrhage

To understand the pathology, it helps to know the anatomical features of the central nervous system. The brain is surrounded by the meninges: the dura mater, the arachnoid mater, and the pia mater. They perform a protective function and are partly responsible for supplying nutrients to brain tissue.

First the brain is covered by the pia mater, then by the arachnoid, and the dura mater covers everything else. There is a space between the pia mater and the arachnoid. Cerebrospinal fluid circulates there. It supplies nutrients to the brain substance. When local vessels are damaged, blood enters the subarachnoid space and then spreads through the cerebrospinal fluid cavities and cisterns.

Causes

Traumatic subarachnoid hemorrhage develops as a result of injury. Most often this is a skull fracture or a brain contusion. A broken bone sits in an unnatural position and may damage an artery. The same applies to a contusion: the impact on the brain involves local arteries and veins in the injury, leading to their damage. When the integrity of the vessel walls is disrupted, blood escapes from the arteries and veins. It accumulates in the nearest plane of least resistance, the subarachnoid space.

Symptoms

The clinical picture of subarachnoid hemorrhage involves three syndromes:

1. Intracranial hypertension.

Because of massive bleeding, pressure inside the skull rises. This causes the following symptoms:

• a rapidly intensifying, acute, tearing headache that resembles a blow to the head; patients often feel increased pulsation in the back of the head;
• the patient adopts a forced position in an attempt to ease the headache;
• dizziness, impaired coordination;
• vomiting and nausea, which partially eases the patient's overall condition;
• feeling unwell, sudden loss of strength;
• darkening in the eyes; visual disturbances may occur because of swelling of the optic disc;
• urination, coughing, and defecation are accompanied by painful sensations.

With a severe rise in intracranial pressure, consciousness is impaired in a brainstem pattern: the patient becomes sluggish, apathetic, and stuporous.

2. The second syndrome includes neurological symptoms:

• mydriasis – dilation of the pupil;
• ptosis – drooping of the upper eyelids;
• strabismus;
• diplopia – double vision;
• paresis – partial weakening of muscle strength in the limbs.

3. Meningeal syndrome.

Blood clots in the subarachnoid space undergo enzymatic breakdown, which is accompanied by aseptic inflammation, that is, inflammation without infection. Meningeal syndrome includes the following symptoms:

• pronounced headache;
• nausea;
• vomiting that is not related to eating and does not bring relief to the patient.

In severe cases, meningeal syndrome is accompanied by mental and neurological disorders:

• hallucinations;
• alternating psychomotor agitation and drowsiness;
• impaired consciousness in the form of apathy and indifference up to a comatose state;
• seizures;
• increased muscle tone, especially of the neck muscles – this leads to a characteristic posture in which the head is thrown back; this position is called the "hunting dog posture."

Mental disorders include hyperesthesia – increased sensitivity. It includes fear of light, sound, strong smells, and tactile touch. With massive bleeding, catecholamines are released into the blood plasma: adrenaline, noradrenaline, and dopamine. They constrict blood vessels and raise blood pressure. As a result, organs suffer: in narrowed arteries the minute volume of blood decreases, tissues develop hypoxia (a state of oxygen deficiency), and they may die. A mass influx of hormones into the blood can lead to cardiopulmonary failure, which in some cases can be fatal.

How to Provide First Aid

If you notice symptoms of traumatic subarachnoid hemorrhage, call an ambulance crew. Until it arrives, you should:

1. Lay the patient down. If he or she is conscious, lay the person on the back; if not, on the side. This prevents vomit from entering the airways.
2. Ensure ventilation of the lungs. Remove outer clothing, open a window in the room, or take the patient out into fresh air.

After the crew arrives, help the paramedics transport the patient to the vehicle. The crew will take the person to the resuscitation and intensive care unit. Keep in mind that in traumatic subarachnoid hemorrhage not all of the symptoms listed above will be present. First of all, pay attention to the "core" of acute cerebral disorder:

1. Medical history. Ask the person whether they have hit their head in the last 24 hours.
2. Acute headache with predominant pulsation in the back of the head.
3. Impaired consciousness. The patient is disoriented, sluggish, and answers questions with a delay. The eyes look "empty," and the person is indifferent to the surrounding world.

These pathologies reduce quality of life and hinder a person from realizing their potential. State hospitals are obliged to provide first aid and manage the patient until recovery. But the next stage of treatment, rehabilitation, may not always receive enough attention.

What Can We Do?

CSM specialists use a comprehensive approach in the treatment and rehabilitation of subarachnoid hemorrhage. What we do:

1. We assess the degree of brain damage: from minor hemorrhages to massive bleeding into the cavities of the brain.
2. We draw up an individual treatment plan for children, adults, and older people.
3. We work on rehabilitating lost neurological functions: we aim to help restore sensation in the arm and the ability to perceive smells and tastes.
4. We work on restoring muscle strength through therapeutic exercise and aim to improve blood supply to the muscles with massage.
5. We work on rehabilitating cognitive function: memory, thinking, attention, speech, and hearing. The aim is to help you hear better, remember well, and speak clearly again.
6. We provide psychologist services for the patient and their loved ones, to help address anxiety, fear, depression, and sleep problems.
7. We help reduce the risk of repeat bleeding and chronic headache by drawing up a nutrition and exercise plan.
8. We aim to support immunity and the body's resistance to harmful factors with physiotherapy methods.

Read Also

• Rehabilitation After Injuries and Surgery
• Rehabilitation Doctor in Kyiv
• PRM Doctor: Who Is This
• Calcification: What It Is and How It Is Treated

Book an appointment: Orthopedic Trauma Specialist Consultation in Kyiv

Sources

• Ukrainian Wikipedia
• Journal "Acute and Emergency Conditions in Medical Practice"