Subarachnoid Haemorrhage in Grand Rapids, Michigan

A subarachnoid haemorrhage (SAH) is a medical emergency that requires immediate treatment at a hospital with neurosurgical and stroke capabilities, such as Corewell Health (formerly Spectrum Health) Butterworth Hospital, Trinity Health Grand Rapids, or other major stroke centers serving the Grand Rapids area.

What Is a Subarachnoid Haemorrhage?

The brain is supplied by an intricate network of blood vessels that carries about one-fifth of the blood pumped from the heart. Around the brain are protective layers called meninges. The subarachnoid space lies beneath the arachnoid layer and is filled with cerebrospinal fluid (CSF).

A subarachnoid haemorrhage is bleeding into this subarachnoid space. It is most often caused by a ruptured aneurysm but can also result from trauma or other blood vessel abnormalities. Without rapid diagnosis and treatment, a subarachnoid haemorrhage can be fatal.

In Grand Rapids and across Michigan, SAH is treated as a time-critical emergency. Anyone with symptoms suggestive of SAH should call 911 immediately rather than driving to the hospital.

Subarachnoid Haemorrhage and Stroke

Types of Stroke

There are two main types of stroke:

  • Ischaemic stroke

    • Caused by a blood clot blocking a blood vessel in the brain
    • Accounts for the majority of strokes

  • Haemorrhagic stroke

    • Caused by a ruptured blood vessel that bleeds into or around the brain
    • Includes:
      • Intracerebral haemorrhage – bleeding within the brain tissue
      • Subarachnoid haemorrhage – bleeding into the space around the brain

About 1 in 10 strokes are haemorrhagic. Subarachnoid haemorrhage is a serious form of haemorrhagic stroke and requires specialized care, which is available at major Grand Rapids hospitals.

Symptoms of Subarachnoid Haemorrhage

Symptoms usually start suddenly and can be severe. Common signs include:

  • Sudden, severe headache (often described as “the worst headache of my life” or a “thunderclap headache”)
  • Decreased level of consciousness or confusion
  • Photophobia (sensitivity to light)
  • Neck pain or stiffness
  • Back pain
  • Nausea and vomiting
  • Seizures
  • Weakness, numbness, or difficulty speaking (similar to other strokes in some cases)

If you or someone near you in the Grand Rapids area experiences these symptoms, especially a sudden severe headache and neck stiffness, call 911 immediately. Rapid transport to the nearest stroke-ready facility (such as Spectrum Health, Trinity Health Grand Rapids, or Metro Health) can be lifesaving.

Causes of Subarachnoid Haemorrhage

1. Cerebral Aneurysm

A cerebral aneurysm is a weak, balloon-like bulge in a blood vessel in the brain. Over time, this weakened area can stretch and deform, becoming unstable and prone to rupture.

Factors that contribute to aneurysm formation include:

  • Hypertension (high blood pressure) – common in Michigan due to lifestyle and dietary patterns
  • Atherosclerosis (hardening and narrowing of the arteries)
  • Family history of aneurysm
  • Smoking
  • Certain connective tissue disorders

When an aneurysm ruptures, it can cause a sudden, massive bleed into the subarachnoid space.

2. Arteriovenous Malformation (AVM)

An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels where arteries connect directly to veins, bypassing normal capillaries. These malformed vessels are fragile and more likely to bleed.

3. Head Trauma

A severe blow to the head, such as from a fall on ice during a West Michigan winter, a car accident on I-196 or US-131, or sports injuries, can damage brain blood vessels and lead to subarachnoid haemorrhage.

Complications of Subarachnoid Haemorrhage

Even after the initial bleed is treated, serious complications can occur. In Grand Rapids, patients with SAH are typically monitored in an intensive care unit (ICU) at hospitals like Corewell Health Butterworth or Trinity Health Grand Rapids.

Rebleeding

Until the damaged blood vessel is repaired, there is a high risk of rebleeding, especially within 24–48 hours after the first haemorrhage. Rebleeding significantly increases the risk of death and long-term disability. The risk is highest during the first two weeks without definitive treatment.

Communicating Hydrocephalus

Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) in the brain’s ventricles (cavities), leading to increased pressure.

  • After SAH, blood can block the arachnoid villi, which normally reabsorb CSF.
  • When CSF cannot be reabsorbed properly, communicating hydrocephalus develops.
  • Symptoms can include headache, confusion, drowsiness, and difficulty walking.

This may require placement of a drain or a shunt to remove excess fluid.

Cerebral Oedema

Cerebral oedema is swelling of the brain tissue, often caused by lack of oxygen and the inflammatory response after a bleed.

  • This swelling increases pressure inside the skull.
  • It can further reduce blood flow to the brain and worsen brain injury.

Seizures and Epilepsy

Damaged brain cells can send abnormal electrical signals, causing seizures. Symptoms may include:

  • Jerking movements
  • Temporary loss of consciousness
  • Changes in sensation or behavior

If a person has three or more seizures after SAH, this may be diagnosed as epilepsy, requiring long-term medication.

Cerebral Vasospasm

Cerebral vasospasm is one of the most serious causes of complications and death in people who survive the initial subarachnoid haemorrhage.

  • Substances released into the CSF after SAH can cause brain blood vessels to spasm (narrow).
  • This narrows the vessel, decreases blood flow, and can lead to delayed stroke.
  • Vasospasm typically occurs 1 to 28 days after the bleed, with peak risk between days 7 and 14.

In Grand Rapids ICUs, patients are closely monitored for signs of vasospasm using neurological exams and imaging, and treated promptly to maintain blood flow to the brain.

Diagnosis of Subarachnoid Haemorrhage in Grand Rapids

Rapid and accurate diagnosis is critical. Local hospitals in Grand Rapids use advanced imaging and testing, including:

CT Scan (Computed Tomography)

  • A CT scan of the head is usually the first test.
  • It can quickly show:
    • The presence and extent of subarachnoid blood
    • Some complications, such as hydrocephalus
  • CT is widely available in Grand Rapids emergency departments.

Lumbar Puncture (Spinal Tap)

If the CT scan is normal but suspicion for SAH remains high, a lumbar puncture may be done:

  • A needle is inserted into the lower back to collect CSF.
  • The fluid is examined for blood or breakdown products of blood.
  • This helps confirm or rule out SAH when imaging is not definitive.

Intra-Arterial Digital Subtraction Angiography (IADSA)

Also called cerebral angiography, this is a detailed imaging test of brain blood vessels:

  • A catheter is threaded through an artery (often from the groin) to the vessels in the neck and brain.
  • Contrast dye is injected, and X-ray images are taken.
  • This is the gold standard for identifying aneurysms and AVMs.
  • Used frequently in major Grand Rapids hospitals with neurosurgical services.

MRI and MRA (Magnetic Resonance Imaging / Angiography)

  • MRI uses strong magnetic fields to create detailed images of the brain.
  • MRA focuses on blood vessels and can show aneurysms or other abnormalities.
  • These are non-invasive and often used for follow-up imaging or when CT is inconclusive.

Treatment for Subarachnoid Haemorrhage

Treatment in Grand Rapids is typically provided in specialized stroke and neurosurgical units at facilities like Corewell Health Butterworth, Trinity Health Grand Rapids, Metro Health, and other regional centers.

Goals of Treatment

  • Stop the bleeding or secure the source (aneurysm/AVM)
  • Prevent rebleeding
  • Manage complications (hydrocephalus, vasospasm, seizures, infection)
  • Support breathing, blood pressure, and brain function

Surgical and Endovascular Treatment

Treatment depends on the cause and location of the bleed, the patient’s condition, and the expertise available.

1. Surgical Clipping

  • A neurosurgeon performs a craniotomy (opening in the skull) to access the brain.
  • The ruptured aneurysm is located.
  • A small metal clip is placed across the neck of the aneurysm to stop blood flow into it.
  • If the aneurysm is in a difficult location or has an unusual shape, clipping may not be possible.
  • Sometimes the general area is also wrapped to help contain the bleeding.

2. Endovascular Coiling

  • Performed by an interventional neuroradiologist or endovascular neurosurgeon.
  • Using IADSA guidance, a catheter is threaded through blood vessels to the aneurysm.
  • Tiny platinum coils are placed inside the aneurysm until it is filled.
  • The coils promote clotting inside the aneurysm, sealing it off from circulation and preventing further bleeding.
  • Coiling is less invasive than open surgery and is commonly used when appropriate in Grand Rapids hospitals.

Conservative (Non-Surgical) Management

Neurosurgery may not be an option when:

  • No clear cause of the SAH is found
  • The aneurysm or AVM is too risky to treat
  • The haemorrhage is too extensive or the patient is too unstable

In these cases:

  • Drainage of blood or CSF from the subarachnoid space or ventricles may be performed to reduce pressure.
  • Patients are monitored closely in the ICU for a set period to watch for:
    • Rebleeding
    • Vasospasm
    • Hydrocephalus
    • Seizures
  • Supportive care includes blood pressure control, pain management, and prevention of complications like blood clots and infections.

Risks and Complications of Surgery

All brain surgery carries risks. For subarachnoid haemorrhage, potential complications include:

  • Death (especially in severe cases or when treatment is delayed)
  • Stroke or additional brain injury
  • Infection
  • Bleeding during or after surgery
  • Seizures
  • Hydrocephalus requiring long-term shunt placement
  • Cognitive and physical impairments requiring rehabilitation

Despite these risks, leaving a subarachnoid haemorrhage untreated carries a very high chance of death or severe disability. In most cases, the benefits of prompt treatment at a specialized center far outweigh the risks.

Recovery and Rehabilitation in Grand Rapids

Survivors of subarachnoid haemorrhage often need:

  • Inpatient rehabilitation (physical, occupational, and speech therapy)
  • Outpatient therapy for ongoing recovery
  • Long-term follow-up with:
    • Neurologists
    • Neurosurgeons
    • Primary care providers

Grand Rapids offers a range of rehabilitation services through:

  • Corewell Health Rehabilitation programs
  • Trinity Health Grand Rapids rehab services
  • Specialized outpatient therapy centers across Kent County

Patients may experience:

  • Fatigue
  • Memory or concentration problems
  • Headaches
  • Mood changes (anxiety, depression)

Support groups and counseling services are available locally and through regional stroke and brain injury programs.

Local Risk Factors and Prevention in West Michigan

Living in Grand Rapids and West Michigan, certain factors can influence your risk:

  • Cold winters and icy conditions increase the risk of falls and head injuries.
  • High rates of hypertension and high cholesterol in Michigan contribute to aneurysm formation and stroke risk.
  • Smoking and poor diet (high in salt and processed foods) are common modifiable risk factors.

To reduce your risk of subarachnoid haemorrhage and other strokes:

  • Control blood pressure, cholesterol, and diabetes with the help of your healthcare provider.
  • Quit smoking.
  • Maintain a healthy weight and stay active year-round (consider indoor walking tracks or gyms during winter).
  • Limit alcohol intake.
  • Wear helmets for biking, skiing, and contact sports.
  • Use fall-prevention strategies in icy weather (proper footwear, salt on walkways, handrails).

The Kent County Health Department and Grand Rapids Public Health offer resources on blood pressure screenings, smoking cessation, and healthy living programs that can support stroke prevention.

Where to Get Help in Grand Rapids, MI

In an emergency, always call 911. Do not drive yourself or someone with suspected stroke or subarachnoid haemorrhage to the hospital.

Local resources include:

  • Emergency Departments / Stroke Centers

    • Corewell Health (Spectrum Health) Butterworth Hospital
    • Trinity Health Grand Rapids
    • University of Michigan Health-West (Metro Health)
    • Other regional hospitals with emergency and neurology services

  • Specialists

    • Neurologist – for diagnosis, medical management, and follow-up
    • Neurosurgeon – for surgical or endovascular treatment
    • Primary care doctor – for risk factor management and coordination of care

  • Public Health and Community Resources

    • Kent County Health Department – screening programs, health education
    • Grand Rapids Public Health programs – chronic disease management, wellness initiatives

Key Points About Subarachnoid Haemorrhage

  • A subarachnoid haemorrhage is bleeding into the space around the brain, usually from a ruptured aneurysm or trauma.
  • It is a type of haemorrhagic stroke, which is less common than ischaemic stroke but often more severe.
  • Symptoms include sudden severe headache, decreased consciousness, neck stiffness, nausea, vomiting, and sometimes seizures.
  • Immediate emergency care at a stroke-capable hospital in Grand Rapids is essential; call 911 right away.
  • Diagnosis typically involves CT scan, lumbar puncture, and angiography (IADSA); MRI/MRA may also be used.
  • Treatment may include surgical clipping, endovascular coiling, or conservative management with intensive monitoring.
  • Surgery and procedures carry risks, including death, but untreated subarachnoid haemorrhage is often fatal.
  • Managing blood pressure, avoiding smoking, and preventing head injuries are key prevention strategies for residents of Grand Rapids and West Michigan.