It is a perfectly ordinary Saturday evening. Tom Achtern*, 53, father of two teenagers, is out for a walk with his wife and the dog – relaxed, totally stress-free, with no inkling of what is to come. “We were perhaps just 500 metres from home when it suddenly hit, like a blow,” he recalls. “A pain as if someone had rammed a metal cone into my head.”

This moment marks the beginning of a medical crisis that pushes him and his family to their limits, and at the same time shows just how crucial swift action is in the event of a brain haemorrhage. Tom Achtern stops in his tracks, clinging to his wife, Bea*: “I knew straight away that this was not just a normal headache. I had to turn back, otherwise I wouldn’t have made it home.” His wife has no real hesitation – the pain is too intense, too sudden. At his request, she calls the emergency services.

The paramedics initially suspected a migraine. “It’s unusual if you’ve never had a migraine before, but it can’t be ruled out,” recalls Achtern. To be on the safe side – and to rule out anything worse – the paramedics take him to A&E.

They try oxygen at the hospital, suspecting a cluster headache. The pain persists. A CT scan initially shows nothing out of the ordinary. Achtern refused a lumbar puncture – extracting cerebrospinal fluid from the spinal canal in the lumbar region – which could have provided clarity, fearing complications. He is given painkillers overnight, which offer little relief. The next morning, after the shift change, the senior consultant on duty looks at the images from the night before and delivers the suspected diagnosis that changed everything: subarachnoid haemorrhage. If this diagnosis is correct, the patient’s life is in danger.

What happens in the brain

A subarachnoid haemorrhage is considered the most dangerous form of cerebral haemorrhage. It usually occurs suddenly and without warning and is always acutely life-threatening. The blood collects between the meninges, presses on the brain and can impair vital functions. In most cases, it is caused by a ruptured aneurysm, in other words, a bulge in a blood vessel.

In much rarer cases, a blood vessel ruptures spontaneously, without any apparent cause. The main symptom is a sudden, extremely severe headache, often accompanied by nausea, vomiting and a stiff neck. Doctors refer to this as a “thunderclap headache”, a term that fits Achtern’s description with frightening accuracy.

Other forms of cerebral haemorrhage include

• Intracerebral haemorrhage: Here, blood enters the brain tissue directly. It is the most common form of spontaneous cerebral haemorrhage and is usually caused by long-standing high blood pressure. Around 5% to 15% of all strokes are attributable to this type of haemorrhage.

• Subdural haemorrhage: The blood collects between the hard meninges (dura mater) and the surface of the brain. It often occurs following falls or head injuries, particularly in older people or those taking blood thinners. It can be acute or chronic.

• Epidural haemorrhage: This usually occurs following a traumatic brain injury, such as an accident. It involves a ruptured artery between the skull and the dura mater. Symptoms can deteriorate dramatically within minutes – immediate surgery is life-saving.

The thing common to all these forms is that they are medical emergencies requiring rapid hospital admission. This is because the haemorrhage increases pressure within the skull, which can endanger vital brain structures.

When every second counts

Any brain haemorrhage is a medical emergency. Among spontaneous haemorrhages, a subarachnoid hemorrhage has the poorest prognosis, as it often occurs suddenly and is associated with high early mortality and severe complications. According to the World Health Organization, it is fatal in around 30% to 50% of those affected. Around 15% die before even reaching hospital. Even with the benefit of optimal intensive care, only about a third survive without permanent impairment.

The haemorrhage can damage brain tissue and the rising pressure compresses vital structures. Immediate hospitalisation via the emergency services is absolutely essential. Diagnosis is usually made via a CT scan. If this is normal, a lumbar puncture can help detect blood in the cerebrospinal fluid. If a haemorrhage is confirmed, the situation determines the treatment: surgical decompression, aneurysm occlusion or conservative management with medication and monitoring.

Hovering between life and death

Following the diagnosis, Tom Achtern is immediately transferred to a university hospital. An angiography – an imaging procedure, used to visualise blood vessels – confirms the subarachnoid haemorrhage. “That’s when I realised my life was in danger,” he says.

The one bit of good news is that it is a non-aneurysmal subarachnoid haemorrhage, a rare, significantly milder form, as the risk of complications and permanent damage is lower. Treatment for Achtern begins in the intensive care unit – close monitoring, medication to prevent possible vascular spasms (vasospasms) that could trigger circulatory problems and damage to the brain.

“The doctors said every day counted now,” his wife recalls. For two weeks, he is barely allowed to leave his bed. Every morning, an ultrasound scan checks whether the blood vessels are narrowing and the haemorrhage is resolving. “I was one of the lucky ones,” Achtern says. “There were no complications. I was able to go home on Christmas Eve.”

Returning to life

After three weeks in hospital, Tom Achtern is finally allowed to go home. Physically, he is recovering well, but coming to terms with it emotionally takes longer. “I often asked myself: Why me? I didn’t have high blood pressure, no risk factors.” Such questions are typical after surviving a brain haemorrhage. The experience of having been so close to death leaves its mark. “I am grateful to the doctors, to my wife and my children – for life,” he says.

Tom Achtern’s story shows just how treacherous a brain haemorrhage can be – and how important it is to take warning signs seriously. A sudden, unbearable headache is not a harmless symptom, but can indicate a life-threatening haemorrhage. Thanks to modern diagnostics and treatment, those who react quickly now have a high chance of survival. “I was lucky in my misfortune,” says Achtern quietly. “And I now know that every walk I go on can be a gift.”

*The names of the family have been changed to guarantee their privacy and protect Tom Achtern from potential negative ramifications, e.g. in the workplace, by publicly discussing his medical history