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Everything You Need to Know about Subarachnoid Hemorrhages
– Brain Injury FAQ

Spontaneous subarachnoid hemorrhages in infants are quite uncommon, but this condition can have profound consequences. There are several essentials to keep in mind in relationship with this brain problem.

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What is a Subarachnoid Hemorrhage?

A subarachnoid hemorrhage is bleeding that occurs in the hollow space between the skull and the brain matter. This cavity is typically filled with a fluid that acts as a cushion and protects the brain from impact.

Whenever a bleeding occurs, the blood pools around the brain and it may potentially irritate the lining. What’s even more troublesome is the fact that the intracranial pressure may increase. As a result, some of the brain cells may become damaged.

How Common are Subarachnoid Hemorrhages in Children?

Elk & Elk

Pediatric subarachnoid hemorrhages happen to be quite rare. These may eventually be caused by trauma, an aneurysm, tumors, and malformations.

The condition is commonly linked to strokes in babies and children. Childhood stroke has an incidence rate of two to three per 100,000. Of these conditions, 1.1 in 100,000 cases are hemorrhagic strokes, and 0.3 are caused by a subarachnoid hemorrhage (SAH). Whenever SAH is not caused by trauma (the most common cause), it is typically the result of an aneurysm.

Intracranial aneurysms are very rare in babies, children, and adolescents. In the period from 1939 to 2011, there have been 1,200 cases. The condition tends to affect boys more than it affects girls. About two-thirds of these aneurysms will eventually become symptomatic, and a hemorrhage will become present.

Literature about the incidence of SAH in individuals under the age of 18 is both rare and inconsistent. There is consent among medical professionals, however. Pediatric intracranial aneurysms and SAH are seen as conditions that differ from those occurring in adults.

Such aneurysms are very rare in newborns and babies aged up to one year. Review of medical literature has identified 131 cases occurring in the period from 1966 to 2005. In children aged up to 15, the occurrence of aneurysms and SAH is 0.05 to 0.09 cases out of 100,000.

The chance of intracranial aneurysm and SAH development is 35 times higher in adults than it is in children, the review published in the Current Pediatric Reviews journal suggests.

What are the Symptoms?

As already mentioned, SAH is rarely asymptomatic. Sooner or later, certain signs will suggest that something may be wrong. A few of the most common ways in which a subarachnoid hemorrhage manifests itself include the following:

  • Headaches
  • Dizziness and motor function deficiencies/disturbances
  • Loss of vision
  • Nausea and vomiting that typically accompany the pain
  • Meningeal irritation symptoms
  • Photopia (a fear of light)
  • Loss of consciousness or seizures
  • Elevation in blood pressure
  • Tachycardia
  • A fever
  • Hemorrhages from the retinas
  • Cardiac dysfunction
  • Confusion and irritability

What are the Causes of SAH?

Some light has already been shed on the causes of subarachnoid hemorrhage in babies and children. As already mentioned, such bleeding will most typically occur as a result of a head trauma.

Aneurysms are the second most common cause.

Arteriovenous malformation bleedings may lead to SAH less frequently. A few other less prominent causes of the condition include a bleeding disorder, blood pressure problems, drug use, the use of blood thinners, fibromuscular dysplasia, a history of polycystic kidney disease and idiopathic causes.

Children born in families that have a high risk of aneurysms are also more likely to suffer from SAH than others.

What are the Exams for SAH?

An SAH diagnostic process will typically be recommended for children who have experienced head trauma and the ones that exhibit some of the symptoms of the condition.

Doctors will typically recommend the use of imaging technology in children that have a stiff neck, motor problems or intense headaches. The process will usually start with an eye exam. A decrease in eye movement or bleeding may be indicative of a much more serious issue.

A head CT scan is the first diagnostic process that will be recommended. If a hemorrhage is small, however, the CT scan may produce a normal result. Other diagnostic tools that may be used include the following:

  • A CT scan that is enhanced through the use of contrast dye
  • Magnetic resonance imaging (MRI)
  • Magnetic resonance angiography (MRA)
  • CT scan angiography
  • Lumbar puncture (this rather invasive diagnostic practice isn’t recommended unless there are serious suspicions. A lumbar puncture involves the insertion of a needle in the spine to draw out cerebrospinal fluid. If the fluid contains traces of blood, there is sufficient evidence that a hemorrhage has occurred.)

Are Treatments Available?

The cause of the bleeding and its severity will help medics determine whether a treatment will be required. In some instances, medical supervision will be sufficient.

Staying at an intensive care unit is recommended for 10 to 14 days after SAH has been diagnosed. Strict supervision will be required to make sure the symptoms aren’t worsening. Medics will also examine the patient for signs of permanent brain damage.

Pain medications may be prescribed to relieve the headaches. If a ruptured aneurysm is the cause of SAH, surgery may also be required. Two of the options that can be used to stop the bleeding and control the size of the hemorrhage include surgical clipping and endovascular coiling.

In cases when the intracranial pressure has increased significantly, cerebrospinal fluid and blood may be drained. A lumbar or a ventricular drain will be used for the purpose. Also, medications will be prescribed to lower the blood pressure and prevent the further increase of the intracranial pressure.

The recovery period and the prognosis for children suffering from SAH varies from one person to another. The cause and the severity of the bleeding are obviously the most important factors. In general, about a third of the people suffering from such a hemorrhage will recover without further complications. In a third of the cases, however, permanent damage will occur.