The aim was to study stress in the acute and post-acute phase in patients with severe traumaticbrain injury (TBI) or non-traumatic subarachnoid hemorrhage (SAH) who were treated at theneurointensive care unit (NICU). Hair cortisol is a biomarker of stress via alterations in hypothalamuspituitary-adrenal axis activity, where cortisol from plasma is continuously incorporated intogrowing hairs at their roots. As hair grows at an average of 1 cm/month, concentrations of haircortisol can also be used to measure stress levels retrospectively.

Hair samples were collected at an interval of one month until three months, with the first cut atadmission to the NICU. The patients (or their relatives, if the patient was unable to communicate)were interviewed about psychological or physical stressors during the previous months.

We present a 28-year-old woman suffering from a subarachnoid hemorrhage (SAH), studied withrepeated haircuts. She experienced the sudden onset of a severe headache. The general practitionersdiagnosed it as migraine or wry neck. Three weeks later, she experienced another attack ofsevere headache. A CT scan showed an SAH. Six months after the SAH, the patient developedhydrocephalus and was successfully treated with a VP shunt. In this case, hair cortisol was elevatedduring the pre-hospital month (probably because of pain and stress due to a sentinel or “warning”leak), during the intensive care period and until two months after the SAH. It then normalized, butit was elevated again at the time at which the patient developed hydrocephalus. At the nine-monthhaircut, her hair cortisol had again normalized.

This case indicates that hair cortisol measurement is a promising method for studying stress,retrospectively and during recovery, in patients suffering from SAH.