The clinical spectrum of aneurysmal subarachnoid hemorrhage

Delays in diagnosis are one of the major problems in the treatment of aneurysmal subarachnoid hemorrhage (SAH). To study reasons for delayed diagnosis, we reviewed the symptoms of 286 patients seen between 1978 and 1985. Delays in diagnosis occurred in 56 patients (19%). Less than half of our patients had the complete classic syndrome of the sudden onset of a violent headache, with or without alteration in consciousness, accompanied by nuchal rigidity. Many patients had atypical symptoms. Gradual evolution of symptoms, nonintense headaches, severe pain at other sites, disturbed consciousness, or mild meningeal signs often lead to misdiagnosis. Nine patients with preserved consciousness had minimal or no headache. Based on our experience, atypical symptoms are common with SAH and need to receive more emphasis.