Treatment goals include lifesaving measures, relief of symptoms, repair of the cause of the bleeding, and prevention of complications.

Treatment for coma or decreased mental status may be required, including positioning, airway protection, and life support, and placement of a drain (small plastic tube into the fluid-filled spaces within the brain—ventricles—to relieve intracranial pressure).

If a person is conscious, strict bedrest may be advised, accompanied by measures to avoid increases in intracranial pressure (pressure in the head). This may include avoiding activities such as bending over, straining, sudden position changes, or similar activities.

Stool softeners or laxatives may prevent straining during bowel movements.

Pain killers and anti-anxiety medications may be used to relieve headache and reduce intracranial pressure. Antihypertensive medications may be used to moderately reduce blood pressure if it is very high. Phenytoin or other medications may be used to prevent or treat seizures. Nimodipine (a calcium channel blocker) is used to prevent vasospasm (spasm of a blood vessel).

Treatment is usually required, which may be either via a craniotomy (opening a hole in the skull) and clipping of the aneurysm (placing a metal clip across the base of the aneurysm so as to separate it from the circulation), or endovascular coiling (placing platinum coils within the aneurysm from the inside of the blood vessel itself). Surgical removal of large collections of blood may also be needed.

How well a patient with SAH does depends on the locaiton and extent of the bleeding, as well as any complications. Complete recovery can occur after treatment, but death may occur in some cases with or without treatment.

• Stroke
• Seizures
• Side effects of medications (see the specific medication)
• Complications of surgery

Go to the emergency room or call the local emergency number (such as 911) if symptoms of subarachnoid hemorrhage are present. Emergency symptoms include seizures or breathing difficulties; loss of consciousness; difficulties with speech, vision, movement, or sensation; and eating or swallowing difficulties.

Kirmani JF, Alkawi A, Ahmed S, et al. Endovascular treatment of subarachnoid hemorrhage. Neurol Res. 2005;27 Suppl 1:103-7.

Edlow JA. Diagnosis of subarachnoid hemorrhage. Neurocrit Care. 2005;2(2):99-109.

Bird S. Failure to diagnose: subarachnoid haemorrhage. Aust Fam Physician. 2005 Aug;34(8):682-3.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:2362-2363.