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Brain Education: Subarachnoid Hemorrhage

Image reprinted with permission from Medscape.com, 2011. Available at: medscape.com

Subarachnoid Hemorrhage

• Symptoms
• Diagnosis
• Treatment
• Risks
• Prognosis

Symptoms

• The most common presentation of intracranial aneurysm is subarachnoid hemorrhage.
• On presentation, patients typically report experiencing the worst headache of their lives. The association of meningeal signs should increase suspicion of SAH.
• “Sentinel” or warning headaches may result from an aneurysm that leaks for days to weeks prior to rupture. Only a minority of individuals have a sentinel headache prior to aneurysm rupture.
• Nausea and vomiting associated with a severe headache
• Drooping eyelid
• Sensitivity to light
• Change in mental status or level of awareness
• Seizures
• Some may lose consciousness briefly or go into prolonged coma. 
• Vasospasm is the leading cause of disability and death from aneurysm rupture. Of patients with SAH, 10% die before reaching medical attention and another 50% die within one month. Fifty percent of survivors have neurological deficits.
• Ruptured aneurysms are most likely to rebleed within the first day (2–4%), and this risk remains very high for the first two weeks (about 25%) if left untreated.
• Early referral to a hospital that has physicians experienced in treating intracranial aneurysms, early treatment (open surgery and clipping or endovascular coiling), and aggressive treatment of vasospasm are three factors that have been correlated with improved outcomes.

Diagnosis »