Nonaneurysmal Subarachnoid Hemorrhage: A Review of Clinical Course and Outcome in Two Hemorrhage Patterns

Linda L. Herrmann; Joseph M. Zabramski


J Neurosci Nurs. 2007;39(6):135-142. 

In This Article

Sequelae Following a Nonaneurysmal Subarachnoid Hemorrhage Pattern

After an SAH, patients may report persistent headaches. The headaches are a normal aspect of the recovery process and gradually resolve as the subarachnoid blood dissipates. Use of a standardized pain assessment scale provides a consistent method to rate a patient's headache and evaluate the effectiveness of analgesia. Collaboration with the neurosurgical team regarding the patient's initial and follow-up CT scans may help establish whether hydrocephalus may be contributing to a patient's headache. For this patient population, the incidence of hydrocephalus upon admission is low (1%–2%), as is the number of patients that require placement of a ventricular shunt (Rinkel, Wijdicks, Hasan, et al., 1991; van Gijn et al., 1985).

The incidence of delayed cerebral ischemia or vasospasm is also low for this patient population (Brismar & Sundbarg, 1985; Rinkel, Wijdicks, Vermeulen, et al., 1991; Schievink et al., 1994; van Gijn et al., 1985). Nonetheless, this poorly understood phenomenon could affect patient outcome. TCDs performed three times a week while a patient is hospitalized are useful for evaluating the presence of vasospasm.

Patients are usually hospitalized for 7 to 10 days following the SAH. The duration of hospital stay depends on the course of care. For example, a patient with hyponatremia will have a slightly longer stay than a patient without hyponatremia.

On occasion, a patient may initially display cognitive deficits related to the SAH. Sedation and sleep deprivation issues may also arise during hospitalization. In addition to routine orientation questions, a cognitive assessment by a speech and language pathologist with daily follow-up is an appropriate intervention. It is important to emphasize the significance of a cognitive evaluation as part of the neurological assessment.