How to Survive the Worst Type of Stroke


There are two main types of hemorrhagic stroke…

Subarachnoid hemorrhage.

About half of hemorrhagic strokes occur in the subarachnoid space, between the inner and middle layers of tissue that cover the brain.

What happens:

Most subarachnoid hemorrhages are caused by a ruptured aneurysm, a bulge in an artery wall that tends to develop after age 40, due to years of high blood pressure. It can also be congenital (present at birth). An aneurysm that doesn’t bleed isn’t necessarily a problem—you can have one for decades and not know it unless it shows up during an imaging test for some other condition.


But once an aneurysm “bursts” and bleeds, you will likely have a “thunderclap” headache that gets progressively worse—and may be followed by a brief loss of consciousness. You may also have blurred vision or loss of vision and/or pain behind and above one eye. Permanent brain damage or death can occur within hours or even minutes. Get to an ER.

Next steps:

This type of stroke can be quickly identified with a CT scan or an MRI, and with magnetic resonance angiography (MRA) and/or cerebral angiography (a catheter is used to inject a dye, which illuminates blood vessels in the brain). Once the damaged artery is identified, there are two main choices…

• Clipping, the traditional approach, is done under general anesthesia. A surgeon creates an opening in the skull (craniotomy), locates the aneurysm and seals it off with a titanium clip that remains on the artery permanently.

• Endovascular coiling is a newer approach. With this minimally invasive technique, there is no incision in the skull. A tiny catheter is inserted into an artery in the groin, then threaded through the vascular system (with the aid of a special type of X-ray) until it’s inside the aneurysm. Then a flexible platinum coil is placed within the aneurysm to stop the bleeding.



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