From the Guidelines
Subarachnoid hemorrhage (SAH) typically presents with a sudden, explosive headache often described as the "worst headache of my life," which is the hallmark symptom and occurs in about 80% of patients, as reported in the guidelines for the management of aneurysmal subarachnoid hemorrhage by the American Heart Association/American Stroke Association 1. This severe headache is characterized as being extremely sudden and immediately reaching maximal intensity, often accompanied by other symptoms such as nausea and/or vomiting, stiff neck, photophobia, brief loss of consciousness, or focal neurological deficits. Some key points to consider in the diagnosis of SAH include:
- The onset of headache may be associated with additional signs and symptoms, including nausea and/or vomiting, stiff neck, photophobia, brief loss of consciousness, or focal neurological deficits (including cranial nerve palsies) 1.
- A warning or sentinel headache that precedes the aSAH-associated ictus is also reported by 10% to 43% of patients, which increases the odds of early rebleeding 10-fold 1.
- The clinical presentation of aSAH is one of the most distinctive in medicine, but individual findings occur inconsistently, and because the type of headache from aSAH is sufficiently variable, misdiagnosis or delayed diagnosis is common 1.
- Noncontrast head CT remains the cornerstone of diagnosis of aSAH, with a sensitivity of close to 100% in the first 3 days after aSAH, but advances in magnetic resonance imaging of the brain can often allow the diagnosis of aSAH to be made when a head CT scan is negative and there is clinical suspicion of aSAH 1. It is essential to note that anyone experiencing a sudden, severe headache should seek immediate medical attention, as prompt diagnosis and treatment of SAH significantly improves outcomes, with a high index of suspicion warranted due to the potential for misdiagnosis or delayed diagnosis 1.
From the Research
Subarachnoid Hemorrhage Symptoms
- Subarachnoid hemorrhage is a rare, but life-threatening neurological emergency 2
- Symptoms of subarachnoid hemorrhage include: + Sudden, severe onset of headache 3 + Transient loss of consciousness 3 + Difficulty in walking 3 + Hemiparesis 3 + Ocular signs 3 + Seizure 3
- Warning signs and symptoms of subarachnoid hemorrhage are crucial for early diagnosis and treatment 3
Cerebral Vasospasm and Nimodipine Treatment
- Cerebral vasospasm is a complication of subarachnoid hemorrhage that contributes significantly to morbidity and mortality 2, 4, 5
- Nimodipine has been used to reduce the incidence of cerebral vasospasm after subarachnoid hemorrhage and improve long-term outcomes 2, 4, 5, 6
- Studies have shown that nimodipine can significantly reduce the incidence of poor outcome, mortality, and cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage 6
Clinical Effectiveness of Nimodipine
- A systematic review and meta-analysis found that nimodipine can significantly reduce the incidence of poor outcome, mortality, and cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage 6
- The evidence grading of a poor outcome and its age subgroup in this study was assessed as high, suggesting that nimodipine is a highly effective treatment for patients with aneurysmal subarachnoid hemorrhage, especially those younger than 50 years old 6