Complications

What are the complications of a subarachnoid haemorrhage?

The complications or ill-effects of a subarachnoid haemorrhage include:

• Cerebral vasospasm
  When blood leaks out during an aneurysm rupture, it comes into contact with normal blood vessels. This may irritate the blood vessels, which then go into vasospasm (constriction leading to a narrow lumen). When severe, insufficient blood flows to portions of the brain resulting in a further stroke and even death. Cerebral vasospasm peaks at about 7-10 days after rupture of the aneurysm and can last as long as 2 to 3 weeks. It can be monitored by a combination of careful neurological examination and Transcranial Doppler ultrasound. When clinically apparent, an angiogram is performed. Injection of a drug called Nimodipine, directly into the lumen of the affected arteries during this procedure can relieve vasospasm.
  
  To prevent vasospasm, Nimodipine is given to the patient for a duration of 21 days. Post-operatively, the patient’s blood pressure is often kept a little high and his blood diluted a little to counter possible vasospasm.
• Hydrocephalus
  Blood from a ruptured aneurysm can block the circulation of cerebrospinal fluid (brain fluid), causing a build up of this brain fluid within the ventricles (fluid-containing cavities) of the brain – a condition called hydrocephalus. Pressure in the brain subsequently rises and death can ensue if left untreated. To stop this brain fluid from building up, a temporary drain or a permanent shunt may be placed into the ventricles.
  
  Other possible complications include brain swelling, seizures, cerebral salt wasting, syndrome of inappropriate ADH secretion (SIADH), neurogenic pulmonary oedema (fluid in the lungs) and cardiac (heart) abnormalities.

What is the recovery process?

The recovery process following a ruptured aneurysm is different with every patient. It often depends on the amount of damage in the initial rupture. If the patient has severe damage from the beginning, prognosis is often guarded. On the other hand, if the initial damage is limited and the aneurysm is successfully secured, the chance of a good recovery is much higher. The recovery process, however, may take many months to a year or more. A younger and fitter individual will have a better chance of a good recovery as compared to an elderly and weaker individual.