From the Guidelines
The most characteristic symptom of an arachnoid hemorrhage is a sudden, explosive headache often described as "the worst headache of my life" or a "thunderclap headache," which is reported by 80% of patients who can give a history, as stated in the guidelines for the management of aneurysmal subarachnoid hemorrhage 1.
Signs and Symptoms
The signs and symptoms of an arachnoid hemorrhage include:
- A sudden, severe headache that reaches maximum intensity almost immediately
- Nausea and vomiting
- Neck stiffness or pain (meningismus)
- Sensitivity to light (photophobia)
- Brief loss of consciousness
- Confusion
- Irritability
- Seizures
- Blurred or double vision
- Weakness or numbness on one side of the body
- Difficulty speaking In severe cases, a person might lapse into a coma.
Importance of Early Recognition
It is essential to recognize the warning signs of an arachnoid hemorrhage, as delays in treatment can significantly increase the risk of permanent neurological damage or death, with misdiagnosis associated with a nearly 4-fold higher likelihood of death or disability at 1 year in patients with minimal or no neurological deficit at the initial visit 1.
Diagnostic Approach
The cornerstone of diagnosis is a noncontrast cranial CT scan, which has a high sensitivity for detecting a hemorrhage, especially in the first 12 hours after the event, as noted in the guidelines for the management of aneurysmal subarachnoid hemorrhage 1.
Warning Leaks
Some patients may experience a warning leak or sentinel hemorrhage before a major rupture, which can be a lifesaving diagnosis if recognized early, with the headache associated with a warning leak usually being milder than that associated with a major rupture, but it may last for a few days, as discussed in the guidelines for the management of aneurysmal subarachnoid hemorrhage 1.
From the Research
Signs and Symptoms of Arachnoid Hemorrhage
The signs and symptoms of an arachnoid hemorrhage can vary, but some common indicators include:
- Sudden and severe headache, often described as the worst headache of a person's life 2, 3
- Nausea and vomiting 3
- Confusion, disorientation, and altered mental state 4
- Seizures 4
- Sudden loss of consciousness 5
- Weakness or numbness in the face, arm, or leg 5
- Difficulty speaking or understanding speech 5
- Vision changes, such as double vision or loss of vision 6
- Sudden and severe pain in the neck or back 6
Diagnosis and Treatment
Diagnosis of an arachnoid hemorrhage typically involves:
- Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) to confirm the presence of blood in the subarachnoid space 2, 6
- Lumbar puncture to check for blood in the cerebrospinal fluid 3
- Transcranial Doppler ultrasonography to monitor blood flow in the brain 4 Treatment may involve:
- Medications to control blood pressure and prevent vasospasm, such as nimodipine or nicardipine 2, 5, 6
- Surgery to repair the aneurysm or remove the blood clot 5
- Intensive care unit (ICU) monitoring to manage complications and prevent further bleeding 3, 6
Complications and Outcomes
Complications of an arachnoid hemorrhage can include:
- Cerebral vasospasm, which can lead to delayed cerebral ischemia (DCI) 2, 6
- Rebleeding, which can worsen outcomes 4
- Hydrocephalus, which can require surgical intervention 6
- Ventriculitis, which can increase the risk of infection 6 Outcomes can vary depending on the severity of the hemorrhage, the presence of complications, and the effectiveness of treatment 3, 6