Experts at the Center for Endovascular Surgery specialize in evaluating and treating subarachnoid hemorrhage. Subarachnoid hemorrhage occurs when a blood vessel ruptures at the base of the brain. Blood fills up the subarachnoid space, an area between the brain and the thin tissues that cover it. Causes for subarachnoid hemorrhage include brain aneurysms, arteriovenous malformations or AVM, amyloid angiopathy and head trauma.

Factors that increase the risk for subarachnoid hemorrhage include:

• Family or personal history of aneurysms
• Certain conditions such as polycystic kidney disease, connective tissue disorders and high blood pressure
• Smoking

• A very severe headache that starts suddenly and is often located near the back of the head is the most common symptom of subarachnoid hemorrhage. Even if a patient is prone to headaches or migraines, this headache will feel very different from the normal pattern. It is often described as the "worst headache of your life."
• Losing consciousness
• Inability to move or feel
• Confusion and irritability
• Muscle pain in neck and shoulders
• Nausea and vomiting
• Sensitivity to light
• Seizure
• Problems with vision
• Eyelid drooping
• Eye pupils are different sizes

If the Center's physicians suspect a subarachnoid hemorrhage, they will work closely with the Emergency Departments of Beth Israel Medical Center in Manhattan, Beth Israel's Kings Highway Division in Brooklyn, and St. Luke's-Roosevelt Hospital Center to stabilize the patient. Patients are evaluated and transferred to Roosevelt Hospital's Neuroscience Intensive Care Unit as rapidly as possible. Close monitoring of the patient is combined with support for the patient and their loved ones so as to explain the plan of action.

Based on the patient's subarachnoid hemorrhage symptoms, the Center's physicians may perform the following tests:

• An eye exam. Certain eye movements can indicate damage to the cranial nerve, which can further indicate bleeding in the brain.
• A CT (computed topography) scan, which is usually done immediately to confirm a subarachnoid hemorrhage.
• A lumbar puncture spinal tap to see if the spinal fluid has traces of blood or is yellow (signs of bleeding in the brain).
• Cerebral angiography of blood vessels of the brain, which can pinpoint the exact location of the bleed.
• Transcranial Doppler ultrasound, which is used to look at blood flow through the skull.

Physicians at the Center for Endovascular Surgery treat subarachnoid hemorrhage by one or more of the following strategies:

• Endovascular coiling of brain aneurysm. Tiny coils block blood flow into the aneurysm and prevent rupture.
• Craniotomy (removal of the skull bone to gain access to the brain) and clip ligation of brain aneurysm, in which a clip is placed around the base of the aneurysm to block it off from circulation.
• Endovascular embolization of arteriovenous malformation or AVM, in which a special glue is injected into the AVM to block off the abnormal vessels.
• Radiosurgery of arteriovenous malformation or AVM, in which radiation therapy is delivers directly to the AVM.
• Surgical resection of arteriovenous malformation or AVM.
• Balloon angioplasty for vasospasm.
• Ventriculostomy and ventriculoperitoneal shunt placement to prevent or relieve abnormal buildup of fluid in the brain.
• Craniotomy for decompression of brain edema, the excessive accumulation of fluid in the tissues.