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One third of patients with aneurysmal subarachnoid hemorrhage (ASAH) present with headache only. A prompt diagnosis is crucial, but these patients must be distinguished from patients with non-hemorrhagic benign thunderclap headache (BTH). Headache developed almost instantaneously in 50% of patients with ASAH, 35% of patients with PHM, and 68% of patients with BTH and within 1 to 5 minutes in 19%, 35% and 19% respectively. Loss of consciousness was reported in 26% of patients with ASAH, 4% of patients with PHM and 16% of patients with BTH, and transient focal symptoms in 33%, 9% and 22% respectively. Seizures and double vision had occurred only in ASAH. Vomiting and physical exertion preceding the onset of headache were more frequent in patients with ASAH (69% and 50%) and those with PHM (83% and 39%) than in those with BTH (43% and 22%). Headache developed almost instantaneously in only half of the patients with aneurysmal rupture and in two thirds of patients with benign thunderclap headache. In patients with acute severe headache, female sex, the presence of seizures, a history of loss of consciousness or focal symptoms, vomiting, or exertion increases the probability of ASAH, but these characteristics are of limited value in distinguishing ASAH from BTH. Aneursymal rupture should be considered even if focal signs are absent and the headache starts within minutes. |
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CAT scan
CAT scan,indications for
diplopia
exercise
headache
headache,severe
headache,sudden onset of
headache,thunderclap
headache,worst of life
lumbar puncture
lumbar puncture,indications for
nausea and vomiting
seizure
subarachnoid hemorrhage
treatment of neurologic disorder
unconsciousness
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