Severe headache, a sign of cerebral hemorrhage

Severe headache, a sign of cerebral hemorrhage. A 74-year-old woman experienced a series of critical medical events that began with a severe headache. The episode landed her in an emergency hospital where, following neurological and imaging evaluation, doctors diagnosed her with a subarachnoid hemorrhage, a serious form of bleeding in the brain.

Mrs. P., the family says, was a cheerful, energetic, self-confident person, but who never made a routine of visits to the family doctor. Until one day, when he arrived at an emergency hospital with a severe headache, nausea and vomiting. After a neurological and imaging evaluation, Ms. Paulina received the diagnosis of subarachnoid hemorrhage, in other words, bleeding in the brain.

After a period of initial recovery and discharge, the patient’s family noticed the first hallucinatory episodes, manifested by searching for a non-existent door. In search of an appropriate solution, the family decided to take her to a medical facility specialized in treating complex cases.

“On initial evaluation, I noticed signs that could not be fully explained by subarachnoid hemorrhage. Thus, immediately after admission, we repeated the brain imaging to follow the evolution of the hemorrhage. I found that it was almost completely in remission, but there was a degree of cerebral atrophy. Given the behavioral disturbances and visual hallucinations, I requested a neurocognitive and psychiatric evaluation. Colleagues confirmed the onset of a neurocognitive disorder. In addition, due to the associated risk factors such as obesity and hypertension, we performed new cardiological, diabetes and nutrition tests and consultations, adjusting the treatment accordingly”, explained Dr. Roxana Zugravu, neurologist at Enayati Hospital.

He managed to heal

After a careful and intensive process of surveillance and recovery, the patient was able to recover. In a letter of thanks to the medical team, the patient expressed her gratitude for the care and humanity she received, emphasizing the importance of a united and professional team in her recovery.

Her case highlights the need for thorough evaluations and a multidisciplinary approach in treating complex neurological conditions. Specialists from various medical fields, from neurology to psychology and nutrition, should collaborate to provide personalized treatments and support patients and their families in managing daily challenges.

What is subarachnoid hemorrhage?

Subarachnoid hemorrhage (SHA) is bleeding in the subarachnoid space, which is the area between the arachnoid membrane and the pia mater that surrounds the brain. This area is filled with cerebrospinal fluid, which protects and nourishes the brain. Bleeding in this space can be caused by a ruptured brain aneurysm, head trauma, or other medical conditions.

How is subarachnoid hemorrhage manifested?

Symptoms of subarachnoid hemorrhage are often severe and appear suddenly. The most common manifestations include:

• Intense and sudden headache: It is often described as “the worst headache of my life”.
• Nausea and vomiting: These often occur after a headache.
• Neck stiffness: Caused by irritation of the meninges.
• Photophobia: Sensitivity to light.
• Confusion or loss of consciousness: May range from drowsiness to coma.
• seizures: Occur in some cases.
• Neurological deficits: Weakness, numbness or difficulty speaking.

How dangerous is subarachnoid hemorrhage?

Subarachnoid hemorrhage is considered a medical emergency and can be extremely dangerous for several reasons:

• Risk of recurrence: Patients are at increased risk of rebleeding, which can be fatal.
• Vasospasm cerebral: This is a common complication that can lead to cerebral ischemia (lack of blood in certain areas of the brain), increasing the risk of stroke.
• hydrocephalus: Accumulation of cerebrospinal fluid in the brain due to blockage of its drainage, which can lead to increased intracranial pressure.
• Permanent neurological damage: Even with prompt and appropriate treatment, SAH can leave patients with permanent neurological deficits.

Treatment of subarachnoid hemorrhage

Treatment for SAH depends on the cause and severity of the bleeding. Options may include:

• Surgery: To repair the brain aneurysm, for example by clipping or endovascular embolization.
• Drugs: To control pain, prevent seizures, and manage other symptoms and complications.
• Intensive therapy: For monitoring and managing vital functions and potential complications.

Prognostic

The prognosis for patients with subarachnoid hemorrhage varies widely and depends on how quickly the bleeding is treated, the age and general health of the patient, and the presence of complications. With appropriate treatment, some patients may recover well, but others may be left with significant deficits or may die from complications.