The Aftermath of
Subarachnoid Haemorrhage

For those surviving aneurysmal subarachnoid haemorrhage, neurological complications of the disease
are relatively common. Approximately one third develop a physical or psychological disability. Even with
the best of outcomes complete recovery may take many months

Stroke


One of the effects of SAH is to impair its ability to regulate the delivery of oxygen to the brain. The blood vessels normally entrusted with this task lose the ability to ensure a constant supply of oxygen to the brain and this is termed delayed cerebral ischaemia (DCI). Doctors sometimes refer to vasospasm if the larger vessels develop a narrowed appearence on an angiogram.This state may persist for approximately 10 to 14 days after the bleeding and during this time the patient is at significant risk of suffering stroke. Although the causes of DCI are yet to be fully understood there are a number of treatments which help mitigate its effects.


Stroke during this period of the illness is one of the most important causes of disability following SAH. The term stroke, as used here, refers to the effect of depriving living tissue in the brain of oxygen. This tissue may die as a result and the loss of its function translates as the disability experienced by the patient.



Hydrocephalus


The brain produces cerebrospinal fluid (CSF) that normally circulates around the nervous system buffering and protecting it. If the normal routes of CSF flow are obstructed, for example by blood clot, fluid may build up within the ventricles of the brain and increase the pressure within the head. After SAH this can occur at two points in time. The first is early after the initial bleeding because of mechanical obstruction of CSF flow by blood clot. There is a second peak in occurrence later on because of damage to the normal production and reabsorption apparatus of the CSF.


Hydrocephalus may be treated by:


  • Temporary measures to divert the CSF e.g. lumbar puncture (spinal tap), lumbar drains or ventricular drains placed through a small surgical incision.

  • Permanent CSF diversions e.g. Ventriculo-peritoneal shunt- an operation is carried out to place a tube draining fluid from the brain , tunnelled under the skin down to the abdomen where the tube drains into the tummy. the rate of flow is controlled by a small valve device placed at the same time.


Hydrocephalus can emerge as a problem weeks and months after the inital hospitalisation.



Fatigue


Fatigue is experienced by approximately two thirds of perople recovering from subarachnoid haemorrhage. It is one of the most consistently reported factors that adversely affects quality of life. the effect of fatigue may be compounded by the psychological complications that may follow subarachnoid haemorrhage (see below). For many people fatigue will imporve over time but may require many months. The following should be borne in mind when dealing with fatigue.:


  • Speak to your doctor. Side-effects of medication (e.g. anti-seizure medication or pain medication) can exacerbate the effect of fatigue and adjustments to medication may be helpful. There are rarer, long-term complications of the bodies chemical system of control (the neuroendocrine system) that if untreated may exacerbate such symptoms. Remember too that surviving a subarachnoid haemorrhage does not render one immune to other illness and alternative explanations for new or deteirorating symtoms should be considered.
  • Pace yourself. Increasing physical activity can help wiht chronic fatigue but one must have realistic goals. Set a conservative goal that can be comfortably attained e.g. a short walk, then build the level of acitivity over weeks rather than days. If it feels comfortable one may push the limits a little without doing any harm. If necessary rest and do not view such rest as failure. A short nap in the afternoons may help some.
  • Eat regularly and healthily.
  • Engage without fear A return to work, if possible, offers many benefits including the opportunity to re-engage with social networks. Those around you may not understand the limitations on activity and may misinterpret it as illness. A return to work or education is often best managed in a staged fashion with very modest goals at the begininng and working towards a more usual level of activity over several weeks or months. The employer may have an occupational health department or work with a company that provides such services. It is quite possible your employer has assisted others return after this type of illness previously.



Anxiety and Depression


Symptoms of anxiety and depression are very common after aneurysmal subarachnoid haemorrhage. 40-50% of respondants who make excellent physical recoveries will relate difficulty with employment or relationships one year after their haemorrhage. Many patients will have little recollection of events during their admission but that does not protect from mood-lability subsequently. There is still a point of realisation that one has survived a life-threatening event and the difficulties that can ensue has been likened to Post-traumatic Stress Disorder (PTSD). If such symptoms develop speaking with your family doctor may help as conventional psychological medicine therapies, talking-therapy and pharmacological, may help support one through this period. In many areas there are patient support group where expereince can be be shared. Also consult our links page for other sources of help.