Subarachnoid hemorrhage - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Subarachnoid hemorrhage (SAH) presents as a sudden severe headache, often described as "the worst headache of life," with nausea, vomiting, and photophobia.
This topic focuses on the diagnosis and management of subarachnoid hemorrhage caused by aneurysm (i.e., aneurysmal SAH).
Examination can be normal or may reveal altered consciousness, meningismus, intraocular hemorrhages, or focal findings.
Computed tomography (CT) indicated if subarachnoid hemorrhage is clinically suspected. Lumbar puncture is indicated if CT is unrevealing. Cerebral angiography confirms the presence of aneurysms.
Initial stabilization followed by surgical clipping or endovascular coil embolization is standard therapy. Enteral nimodipine should be started early to prevent vasospasm, delayed cerebral ischemia and improve functional outcomes.

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History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

CT brain showing subarachnoid hemorrhage from a ruptured posterior cerebral artery aneurysm (1 of 2)
CT brain showing subarachnoid hemorrhage from a ruptured posterior cerebral artery aneurysm (2 of 2)
Communicating hydrocephalus in the setting of subarachnoid hemorrhage; note dilation of fourth and temporal horns of lateral ventricles
Severe vasospasm of distal left internal carotid artery and proximal middle and anterior cerebral arteries before (A) and after (B) intra-arterial infusion of nicardipine and transluminal balloon angioplasty
Left frontal infarct (arrows) in a patient with subarachnoid hemorrhage-related vasospasm
Distal left vertebral and basilar arteries spasm before (left) and after (right) intra-arterial Infusion of nicardipine
ECG done on admission of a patient with subarachnoid hemorrhage; note peaked, tall T waves (1 of 2)
Same patient, 24 hours later; note normalization of T waves (2 of 2)

Citations

Key Articles

Thompson BG, Brown RD Jr, Amin-Hanjani S, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015 Aug;46(8):2368-400.[Abstract][Full Text]
Hoh BL, Ko NU, Amin-Hanjani S, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2023 Jul;54(7):e314-70.[Abstract][Full Text]
Steiner T, Juvela S, Unterberg A, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013 Feb 7;35(2):93-112.[Abstract][Full Text]

Referenced Articles

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