Pitfalls in the recognition of subarachnoid hemorrhage

Between January 1970 and January 1978, one hundred eighty-two patients were admitted to the University of Iowa Hospitals for treatment of subarachnoid hemorrhages secondary to a ruptured aneurysm. The correct diagnosis had been delayed in 41 patients, with most treated from four to seven days before the correct diagnosis was established. Generally, these patients were initially less acutely ill than those patients whose conditions were promptly diagnosed. The most common misdiagnoses were systemic infectious illness, migraine headache, and hypertensive encephalopathy. Rebleeding occurred in three patients before the correct diagnosis was made. Atypical symptoms, problems in diagnosis, and the need for prompt therapy are reviewed.