Subarachnoid hemorrhage history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Sara Mehrsefat, M.D. [4]

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”.^[1] 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).

It is critical to obtain a detailed and focused history.^{[2][3][4][5][6][7][8][9][10]}

It is impossible to know whether symptoms are due to ischemia, hemorrhage, or other medical reason 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:^{[8][9][11][10]}

• Severe headache (as a worst headache of the life)
• Double vision
• Nausea and vomiting
• Symptoms meningeal irritation
  • Nuchal rigidity and pain
  • Back pain
  • Bilateral leg pain
• Numbness
• Weakness
• Sudden decreased level of consciousness
• Rapid progression of symptoms
• Speech disturbance

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