Subarachnoid haemorrhage

Tiredness and restlessness

It is common to experience severe tiredness, especially in the first few months after the haemorrhage. You might find that you become exhausted even after commonplace activities like going to the shops, watching television, or talking with your friends. This is because your brain has to concentrate hard to process everything going on around you and so becomes tired very quickly. It is your body’s way of telling you to slow down.

Taking regular short breaks can help. Try to do this at least three times a day for around 20-30 minutes. Listening to your favourite music can help, but try to avoid anything too stimulating like watching television or reading.

You might also find that you have difficulty sleeping at night and can only sleep for short periods. Some people find that aromatherapy helps them relax and sleep. Lavender is a popular fragrance. Citrus oils can help with relaxation but are less likely to make you sleepy. You can place a few drops on a handkerchief by your pillow or use the fragrances in an oil burner.

If you wake in the night and cannot get back to sleep, try getting up and making a hot drink rather than lying there worrying about not sleeping.

It can help to have a daily routine. Try to get up and go to bed at the same times each day. Plan some relaxation breaks during the day. If you have returned to work, you could talk to your employer about the possibility of being given time for extra breaks during the working day.

Headaches

Headaches following your discharge from hospital are common but usually ease with time. They tend not to be as severe as when you had the haemorrhage and can often be controlled with pain-killers like paracetamol and codeine. They might become worse when you are tired. Again, this is your body’s way of telling you to slow down.

It is important you drink plenty of fluids throughout the day: at least two to three litres. This helps blood circulation in the brain and prevents dehydration.

Alcohol, and caffeine-based drinks like cola and coffee, can dehydrate the brain and increase the risk of headaches. Try to avoid caffeine-based drinks, or at least cut down for the first three to six months of your recovery.

It is also important to avoid things that put too much strain on your body like becoming constipated or lifting heavy weights as these can increase the pressure in the brain and so cause headaches.

Unusual sensations

People often say that they experience odd or unusual sensations in their brain which are different from headaches. They are very difficult to explain but people sometimes describe them as “tickly” and something like water running across the surface of the brain. No-one knows why these sensations occur but they are common and are nothing to be concerned about. They will usually ease in time.

Loss of movement and/or feeling

An SAH can cause a loss of movement and/or feeling in your arms or legs. Each individual is affected differently and the severity of the
problems can vary from a slight arm or leg weakness to a complete loss of power.

You might also feel odd sensations in your arms and legs. These can be difficult to describe. The feeling of clothes against the skin or the touch of another person might be exaggerated. Limbs might feel heavy and numb. Some people experience pins and needles. It might be difficult to distinguish between hot and cold, so you should be careful when taking a bath or shower to avoid getting burned.

You can experience any combination of these problems so will need an individual assessment and exercise plan. This plan will be devised for you by a physiotherapist either in hospital or in your home. Try not to over-exercise as this can lead to injury and might delay your recovery. It is better to do little and often.

It can be helpful to apply body lotion or massage oil regularly to your affected limbs. This maintains good skin condition and helps keep your muscles supple.

Senses

Following an SAH, some or all of your senses might be affected, including your sight, smell, taste and touch. The problems will depend on the particular part of the brain affected. Some of the symptoms might be temporary; some might be permanent.

Sight

Your vision might be disturbed in various ways: blurring, blind areas, black spots, or double vision. The doctors will test your vision before you are discharged from hospital. This enables them to monitor any changes over a period of time. These tests will be repeated at follow-up appointments.

If you do have visual problems as a result of the haemorrhage, you might be referred to an eye specialist. Improvements in vision usually take place gradually over weeks and months.

Double vision (diplopia) can be very disturbing. It can help to wear an eye patch over the affected eye for one to two hours, then transfer the patch to the other eye for the same period of time. This will encourage the eye muscles to strengthen and stabilise. Both eyes should be treated the same to prevent one eye from becoming weaker. Your neurologist or optician will be able to advise you further on this technique.

If you already wear glasses or contact lenses it is a good idea to wait for two or three months after the haemorrhage before having your eyes tested regularly again. This is because your vision might take a while to settle down and your glasses or lenses might need changing lots of times while this happens. Of course, this can then become expensive. Your optician will be able to advise you further on the best course of action to take.

Memory

Memory and concentration problems are common following an SAH. You might find it difficult to concentrate for long periods of time and this might make even simple tasks like reading a book or making a cup of tea difficult and frustrating. Try to break tasks down into small steps so you only have to concentrate for short periods of time before taking a rest.

After an SAH, certain parts of your memory might be affected. You might not remember very much about the haemorrhage itself or what happened when you were admitted to hospital. You might find that you can remember things that happened to you a few years ago but find it difficult to remember new information like the name of the person you have just met or a new telephone number.

Many people find that their memory improves with time, although it might never be quite as good as it was before the haemorrhage.

You can ask your GP or neurologist to arrange for you to see a psychologist who can carry out a neuropsychological assessment. Typically, this will involve doing a number of different tests to assess what specific memory and concentration problems you are experiencing.

Here are some tips to help you remember things:

• Keep a book or diary where you write down all the important things you need to remember. Try to keep it in the same place: for example, by the telephone.
• Write down telephone numbers or people’s names
  on a piece of paper as soon as you can. Post-it notes in bright colours can be really useful memory aids as you can stick them everywhere.
• Pictures are often easier to remember than abstract facts. For example, if you meet someone called Anne Fisher you might think of Princess Anne and imagine the person you met wearing a crown and fishing by a river bank. The more bizarre the picture, the easier it will be to remember.
• Try not to get too anxious or stressed as this will make it more difficult to remember information. If you do become anxious, take some deep breaths, breathing in through your nose and out through your mouth.
• Use an alarm clock to help you to remember to do something like make a telephone call or go to an appointment.

Speech

Speech, language and comprehension are complex forms of communication and often disturbed following an SAH. Commonly, people experience problems finding the right word. This is called expressive dysphasia. You might find it difficult to understand what another person is saying. This is called receptive dysphasia.

Communication problems can be very frustrating and you might need the help of a speech and language therapist who can assess your problems and needs. Following the assessment, the speech and language therapist will give you guidance and exercises for you to practise at home.

You might find it helpful to use a picture board. This could be a sheet of paper displaying pictures of everyday items and the alphabet. If you are having difficulty finding words you can point to a specific picture on the board or use the alphabet to spell out what you want to say.

(You might be interested in reading our fact sheet with information on speech and language problems for further details.)

Emotions

Many people find it difficult coming to terms with having had an SAH. You might feel depressed, tearful, angry or anxious for no apparent reason. These feelings can be physical (related to what has happened to your brain), emotional (a reaction to the traumatic experience), or both. Many of these changes are temporary and will improve over time.

It can be helpful to stick to a routine and plan what you are going to do each day, even if it is just going to the shop to buy a newspaper or going for a walk in the park.

As time goes by, it can be hard to express and explain to others how you feel and how you have changed, especially as you might appear to have recovered physically. This can lead to feelings of isolation.

It often helps if you can talk to a friend or relative about how you are feeling rather than keeping your feelings bottled up inside. You might want to talk to your GP about seeing a clinical psychologist or a counsellor.

Feelings and worries

It is natural to feel anxious and to worry about the future, especially when you are back at home. Many people are concerned that the haemorrhage might happen again, although this is very unlikely.

It can be difficult recovering from such a major life event. The first few weeks and months can be a very intense time and you might find that friends and family treat you differently. Everybody has different ways of coping.

If you are struggling to come to terms with what has happened it might be helpful to keep a simple diary of your thoughts and your physical recovery. This will also help you to record how you are improving as time passes.