SAH-CLINICAL FINDINGS

SUMMARY

1. Patients present with typical sudden, unusually severe headaches = thunderclap headache. This is associated with nausea and vomiting.

2. This is a result of extravasation of blood into the CSF space, ventricles or into the brain parenchyma itself.

3. Sentinel haemorrhage may occur in up to 30-60% of patients. This clears within a day.

4. Warning headaches may be due to enlargement of the aneurysm or bleeding confined to the aneurysm wall.

5. Signs – meningismus, hypertension, focal neurologic deficit, ocular haemorrhage, obtundation, coma.

6. Differential diagnosis – SAH, benign thunderclap headaches/crash migraine, benign orgasmic cephalgia.

7. The clinical status is graded according to the World Federation of Neurosurgeons Scale (WFNS).

Reference(s)

Greenberg, M., 1997. Handbook Of Neurosurgery. 7th ed. Lakeland, Fla.: Greenberg Graphics
Quiñones-HinojosaA. (2012). Schmidek and Sweet: Operative Neurosurgical Techniques: Indications, Methods and Results. 6th ed. Saunders.
Rhoton, A.L. and Congress Of Neurological Surgeons (2003). Rhoton cranial anatomy and surgical approaches. Philadelphia: Lippincott Williams & Wilkins.