Question: I had a subarachnoid hemorrhage two years ago, and the doctors were unable to find a cause. What are the chances that this could happen again?

Dr. Hibberd's Answer:

Subarachnoid hemorrhage (SAH) in the absence of infection or trauma is very important to investigate completely. Half of SAH victims die and 10 to 15 percent never reach the hospital. A SAH is regarded as a form of stroke, and accounts for 1 to 7 percent of all strokes. Until proven otherwise, it is assumed that you have a micro-aneurism or arteriovenous malformation. If none is discovered by appropriate imaging, close follow-up and periodic re-evaluation is mandatory.

It is not unusual for the first angiogram to be negative only to find the offending lesion on repeated examinations. Remember, imaging is only a snapshot in time, and not always perfect. You would be wise to maintain low normal blood pressures, avoid overly physical occupations and have a consultation and re-evaluation at a neurosurgical center. Cocaine abuse and sickle cell disorders along with coagulation and bleeding disorders are associated with spontaneous SAH. Until the cause is discovered, your risk of recurrence is unknown!