Subarachnoid Hematoma: A Deeper Dive into Brain Bleeds

Shivendra Pratap Singh


High Court Lucknow

Medico Legal

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Published on: 13 Aug, 2023

A subarachnoid hematoma, often confused with a subarachnoid hemorrhage, refers to the accumulation of blood within the subarachnoid space—the area between the arachnoid and pia mater, which are two of the three layers (meninges) that cover the brain. This condition is a medical emergency, often resulting from trauma or ruptured blood vessels. Let’s delve deeper into the intricacies of this condition.

1. Causes of Subarachnoid Hematoma:

The primary reasons include:

  • Traumatic Injury: A blow to the head or severe injury can cause blood vessels to rupture in the subarachnoid space.
  • Ruptured Aneurysm: An aneurysm is a bulging, weakened spot in a blood vessel that can rupture and bleed into the brain. When it occurs in the vessels near the brain’s surface, it can lead to a subarachnoid hematoma.
  • Arteriovenous Malformations (AVMs): Abnormal tangles of blood vessels can rupture, leading to bleeding in the brain.

2. Symptoms:

A subarachnoid hematoma often presents with:

  • A sudden and severe “thunderclap” headache, often described as the “worst headache of one’s life.”
  • Nausea and vomiting
  • Stiff neck or neck pain
  • Sensitivity to light (photophobia)
  • Blurred or double vision
  • Seizures
  • Loss of consciousness

3. Diagnosis:

  • CT Scan: A computed tomography scan is often the first diagnostic tool used, as it can quickly detect blood in the brain.
  • Lumbar Puncture: If a CT scan is inconclusive, a lumbar puncture (spinal tap) might be conducted. The presence of blood in the cerebrospinal fluid can confirm a subarachnoid hematoma.
  • Angiography: To identify the source of bleeding, especially if an aneurysm or AVM is suspected.

4. Treatment:

  • Immediate Hospitalization: Rapid medical intervention is essential to prevent further bleeding and reduce brain damage.
  • Surgical Clipping: A procedure where a clip is placed around the base of an aneurysm to stop the bleeding.
  • Endovascular Coiling: A less invasive procedure wherein a catheter is used to position a coil in the aneurysm, promoting blood clotting and preventing rupture.
  • Drainage: Sometimes, a drain is placed in the subarachnoid space to reduce the pressure from the accumulated blood.
  • Medications: Drugs can be used to control seizures, relieve pain, or prevent vasospasms (constriction of blood vessels) that can follow a subarachnoid hemorrhage.

5. Prognosis:

The outcome depends on the extent of the bleeding, the time to treatment, and any complicating factors. While some individuals recover fully, others might experience long-term complications or disabilities.

6. Prevention:

While not all cases are preventable, some measures can reduce risk:

  • Manage Blood Pressure: Regular check-ups and maintaining a healthy lifestyle can prevent hypertension, a risk factor for aneurysms.
  • Avoid Smoking: Smoking increases the risk of aneurysms.
  • Limit Alcohol Consumption: Excessive drinking can increase blood pressure and the risk of hemorrhage.


A subarachnoid hematoma is a severe medical condition that underscores the necessity of rapid and effective treatment. Whether resulting from trauma or a medical condition like an aneurysm, understanding the symptoms and ensuring immediate medical care can be life-saving. As with many other conditions, education and awareness are paramount for both prevention and timely intervention.


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