Traumatic Subarachnoid Hemorrhage

Traumatic Subarachnoid Hemorrhage (SAH) in children is a critical form of brain injury characterized by bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater, which surround the brain and spinal cord. This condition is usually caused by head trauma and requires immediate medical attention due to the risk of complications such as increased intracranial pressure, brain ischemia, and vasospasm. In Bangladesh, pediatric traumatic SAH is frequently associated with road traffic accidents, falls, and occasionally non-accidental trauma. Timely diagnosis and expert neurosurgical care can significantly improve the outcomes for affected children. What Is Traumatic Subarachnoid Hemorrhage? Traumatic SAH occurs when traumatic forces cause rupture of blood vessels in the subarachnoid space, leading to bleeding that mixes with cerebrospinal fluid (CSF). This bleeding can irritate the brain tissue and meninges, leading to neurological symptoms and potential secondary brain injury. Unlike spontaneous SAH caused by aneurysm rupture, traumatic SAH is linked directly to external head injury and is a common finding in pediatric traumatic brain injury (TBI). Causes of Pediatric Traumatic SAH in Bangladesh Falls from rooftops, stairs, and trees Road traffic accidents involving motorcycles, rickshaws, and pedestrians Physical abuse and shaken baby syndrome Sports injuries and playground accidents Blunt force trauma from assaults or accidents Symptoms of Traumatic Subarachnoid Hemorrhage in Children Symptoms vary widely depending on the severity but may include: Sudden and severe headache Vomiting and nausea Loss of consciousness or altered mental status Seizures Neck stiffness due to meningeal irritation Weakness or numbness on one side of the body Confusion, irritability, or drowsiness Visual disturbances or abnormal eye movements In infants, bulging fontanelle and poor feeding may be signs Diagnosis Early and accurate diagnosis is crucial to prevent complications. Diagnostic tools include: CT Scan of the Brain: The gold standard for rapid identification of subarachnoid bleeding and associated injuries like skull fractures or brain contusions. MRI Brain: Useful in follow-up and detecting subtle brain injuries. Neurological Examination: Includes Pediatric Glasgow Coma Scale (GCS) and neurological reflex testing. Monitoring for Intracranial Pressure (ICP): Essential in severe cases. Treatment Approach by Dr. Md. Nafaur Rahman Medical Management Close observation in Pediatric Intensive Care Unit (PICU) Control of intracranial pressure with medications such as mannitol and hypertonic saline Seizure prevention with anticonvulsants Pain control and supportive care (oxygen, fluids) Prevention and treatment of complications such as cerebral vasospasm Surgical Intervention Reserved for cases with associated mass lesions like hematomas or brain swelling causing neurological deterioration Procedures include craniotomy for evacuation of hematomas or repair of skull fractures Minimally invasive neurosurgical techniques tailored for pediatric patients to ensure safety and efficacy Prognosis and Complications While many children with traumatic SAH recover with appropriate treatment, complications can include: Rebleeding or worsening hemorrhage Vasospasm leading to stroke or cerebral ischemia Hydrocephalus requiring shunt placement Long-term neurological deficits such as cognitive impairment, motor disabilities, or seizures Increased risk of behavioral and developmental problems Early intervention and specialized pediatric neurosurgical care significantly improve outcomes. Importance of Specialized Pediatric Neurosurgical Care in Bangladesh In Bangladesh, pediatric traumatic brain injuries including SAH require expert care that balances rapid diagnosis with appropriate surgical or medical management. Dr. Md. Nafaur Rahman provides: Expert pediatric neurosurgical evaluation and treatment Access to advanced neuroimaging and intensive care Family counseling and rehabilitation services Awareness programs for prevention of childhood head injuries Contact for Expert Pediatric Neurosurgical Care 📌 Dr. Md. Nafaur Rahman Assistant Professor, Pediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS) Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 Appointment and Emergency Contact: 📱 +8801912988182 | +8801607033535 🌐 Visit: www.neurosurgeonnafaur.com