Subarachnoid hemorrhage history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Sara Mehrsefat, M.D. [3]

Overview

The classic symptom of subarachnoid hemorrhage is thunderclap headache ("most severe ever" headache developing over seconds to minutes). This headache is often described like being "kicked in the head". 10% of all people with this symptom turn out to have a subarachnoid hemorrhage, and is the only symptom in about a third of all SAH patients. Other presenting features may be vomiting (non-specific), seizures (1 in 14) and meningism. Confusion, decreased level of consciousness or coma may be present. Intraocular hemorrhage (bleeding into the eyeball) may occur. Subhyaloid hemorrhages may be visible on fundoscopy (the hyaloid membrane envelopes the vitreous body).

History and symptoms

History

It is critical to obtain a detailed and focused history.

History	Comments
Timing of the symptoms onset	The time the patient was last normal
Initial symptoms	The progression of symptoms
Vascular risk factors	Hypertension Diabetes Hypercholesterolemia Smoking
Medications	Anticoagulants Antiplatelet agents Decongestants Antihypertensive medications Stimulants (including diet pills) Sympathomimetics
Recent trauma or surgery	ICH may be related to hyperperfusion after Carotid endarterectomy Carotid stenting
Dementia	Associated with amyloid angiopathy
Alcohol or illicit drug use	Cocaine Other sympathomimetic drugs
Liver disease	Associated with coagulopathy
Cancer and hematologic disorders	Associated with coagulopathy

Symtoms

It is impossible to know whether symptoms are due to ischemia or hemorrhage based on clinical characteristics alone. The abrupt onset of focal neurologic symptoms is presumed to be vascular in origin.

Non specific symptoms of hemorrhagic stroke may include the following:

• • Severe headache: Headache is the main symptom. It often starts suddenly and starts after a popping or snapping feeling in the head.
• Double vision
• Nausea and vomiting
• Neck pain
• Numbness
• Weakness on one side of the body
• Systolic blood pressure >220 mm Hg
• Severe headache
• Sudden Ddcreased level of consciousness
• Rapid progression of symptoms
• Speech disturbance