Aneurysmal subarachnoid haemorrhage: guidance in making the correct diagnosis

Abstract

Background: The natural history of untreated aneurysmal subarachnoid haemorrhage carries a dismal prognosis. Case fatalities range between 32% and 67%. Treatment with either surgical clipping or endovascular coiling is highly successful at preventing re-bleeding and yet the diagnosis is still missed. Methods: Based on the national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage and a review of other available literature this study has compiled guidance in making the diagnosis. Conclusion: In patients presenting with a suspected non-traumatic subarachnoid haemorrhage, computed tomography within 12 hours will reliably show 98% of subarachnoid haemorrhage. In patients who present after 12 hours with a negative computed tomogram, formal cerebrospinal fluid spectophotometry will detect subarachnoid haemorrhage for the next two weeks with a reliability of 96%. Between the early diagnosis with the aid of computed tomography and the later diagnosis with the added benefit of spectophotometry in the period where computed tomograms become less reliable, it should be possible to diagnose most cases of subarachnoid haemorrhage correctly.

Headache Caused By an Intracranial Aneurysm in a 32-Year-Old Woman

“…12 Patients with SAH frequently have an additional warning sign, a sentinel headache, described as the occurrence of an undervalued or even ignored oppressive headache in the weeks preceding the aneurysm. [13][14][15] Other symptoms may include nausea and vomiting (77%) as well as loss of consciousness (53%). [13][14][15] Associated symptoms, including syncope, diplopia, and seizure, make SAHs more likely.…”

“…[13][14][15] Other symptoms may include nausea and vomiting (77%) as well as loss of consciousness (53%). [13][14][15] Associated symptoms, including syncope, diplopia, and seizure, make SAHs more likely. 12 Figure 1 offers a summary of the signs and associated risk factors that a chiropractor should look for when taking a patient's history.…”

Secondary Headaches

“…When CT was performed within 12 h of SAH, one study showed CT failed to detect the SAH for 1.7% of patients [34]. Lumbar puncture (LP) LP may not detect blood during the first 12 h postbleed; however, CT is most sensitive during this time [39,40]. Computed tomography angiography (CTA) a Negative noncontrast CT plus CTA excludes SAH with a >99% probability [35].…”

Diagnosis and initial management of subarachnoid haemorrhage

“…Photophobia, meningismus, vomiting and syncope soon ensue. If severe headache is the only symptom, the chance of SAH is only 10% 10 .…”

“…It is believed that the SAH causes an inflammatory reaction in the basal cisterns of the brain inducing CV, the most common cause of delayed cerebral ischaemia and neurological deficits after SAH. The risk of CV increases with the amount of blood in the subarachnoid space and typically does not begin before the fourth day after SAH and can last for 14-21 days 10,35 . CV can be detected on radiographic imaging and also by bedside transcranial Doppler studies (TCDs).…”