Subarachnoid hemorrhage

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Central nervous system

Subarachnoid hemorrhage

Alternative Names:

Hemorrhage - subarachnoid
Symptoms:

Headache
- Sudden onset
- Described as the "worst ever experience"
- Can be preceded by a popping or snapping sensation in the head
- Pain described as a new type
- Generalized pain, often worse near the back of the head
Nausea and vomiting may accompany the headache
Decreased consciousness and alertness
- Temporary or progressively worsens to coma and death
Difficulty seeing or changes in vision
- Double vision
- Blind spots
- Temporary loss of vision in one eye
Stiff neck
Photophobia (light bothering or hurting the eyes)
Muscle aches (especially neck pain and shoulder pain)
Seizure or spell
Difficulty or loss of movement or sensation of a part of the body
Changes in mood and personality
- Confusion
- Irritability

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Additional symptoms that may be associated with this disease:

Signs and tests:

About 30% of patients with SAH are misdiagnosed at first. If subarachnoid hemorrhage is suspected, a computed tomography (CT) scan(without dye contrast) of the head should be immediately performed.In some cases, the head CT scan may be normal, especially if there has only been a small bleed.If the CT scan is normal, a lumbar puncture (spinal tap )must be performed. Patients with SAH will have blood in theirspinal fluid.

Cerebral angiography of blood vessels of the brainmay show small aneurysms or other vascular problems. This test can pinpointthe exact location of the bleed.

A physicial exam may reveal a stiff neck due toirritated meninges (the tissues covering the brain).Movement of the neck may be resisted in all but deeply comatose people. There may also be signs ofdecreased nerve and brain function (focal neurologic deficit ).

An eye exam mayalso reveal bleeding in the brain. Decreased eye movements can indicate damage to the3rd or 6th cranial nerve.

SAHmay also alter the results of CPK isoenzymes.

References:

Kirmani JF, Alkawi A, Ahmed S, et al.Endovascular treatment of subarachnoid hemorrhage. Neurol Res. 2005;27 Suppl 1:103-7.

Edlow JA. Diagnosis of subarachnoid hemorrhage. Neurocrit Care. 2005;2(2):99-109.

Bird S. Failure to diagnose: subarachnoid haemorrhage. Aust Fam Physician. 2005 Aug;34(8):682-3.

Marx J. Rosen?s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:2362-2363.