Fairfax Hospital Neuroscience Services - Inova Health System

Hemorrhagic Stroke
What can I expect after a subarachnoid hemorrhage (SAH)?
The rupture of a blood vessel inside the brain is a serious event. Subarachnoid hemorrhage is
graded by the doctors using the amount of bleeding that appears on the CT scan and the severity
of symptoms. Depending on the amount of bleeding, symptoms can range from a mild headache,
to muscle weaknesses, to coma. Most people arrive at the hospital with mild to moderate
symptoms after these types of hemorrhages. In most cases, a full recovery is likely. In the case of
more severe bleeding, it is best to talk to your care team regarding the expected outcome and
course of treatment.
The first step after SAH is to obtain medical imaging such as CT scan, MRI scan, or cerebral
angiogram (discussed above) to look for a cause of the bleeding in the brain. If an aneurysm is
found, it must be treated as quickly as possible to prevent re-bleeding. The first 24 – 48 hours
after the initial bleeding event are critical to prevent re-bleeding. The patient can expect to
remain in the intensive care unit (ICU) during this time, and blood pressure will be tightly
controlled. Doctors and nurses will watch closely for signs of neurological decline. They will
perform frequent neurological exams to check for sleepiness, confusion, speech problems, and
muscle weakness. A new onset of any of these symptoms can indicate new bleeding or one of the
many problems associated with subarachnoid hemorrhage.
The average length of stay in the hospital after SAH is 2 – 4 weeks. Even if the bleeding is
relatively mild, the patient must be watched closely for any of the complications listed below:
Potential Complications of SAH:
• Vasospasm – Because there is blood outside of the normal places in the brain (arteries),
the blood vessels will often react by attempting to close. This is a normal bodily response
to bleeding, and will occur anywhere in the body. However, it is dangerous for this to
occur in the brain, because if the blood flow is completely cut off, a stroke will occur.
Most people have vasospasm 3 – 21 days after the initial SAH event. Several measures
will be taken to prevent, monitor, and manage vasospasm, should it occur. These include:
o Increasing the blood pressure if the aneurysm is repaired. High salt IV solutions
and sometimes IV blood pressure medications are used to increase the blood
pressure. The idea is to increase the blood flow through narrowed arteries in the
brain.
o Nimodipine is a medication taken as a large pill every 2 – 4 hours. This
medication helps relax arteries in the brain to prevent spasm.
o Transcranial dopplers (TCDs) are performed daily at the bedside. This is an
ultrasound test that shows the speed of blood flow through the arteries in the
brain. The technician places a handheld instrument over the openings in the skull
to show if blood flow is blocked or reduced.
• Seizure - You will more than likely be placed on anti-seizure medication for a short
period of time depending on how much bleeding has occurred in your brain.
PATIENT INFORMATION GUIDE FOR STROKE
inova.org/neuro