Diagnosis of spontaneous subarachnoid hemorrhage

Spontaneous subarachnoid hemorrhage is usually the result of rupture of an intracranial saccular aneurysm or arteriovenous malformation. The hemorrhage is typically a cataclysmic event, heralded by severe headache, meningeal signs and neurologic dysfunction. About one-half of patients with aneurysmal rupture experience "sentinel headaches" days to weeks before a major hemorrhage. Diagnosis at this stage may permit treatment before the occurrence of a devastating neurologic event. Clinical suspicion of subarachnoid hemorrhage should be confirmed by computed tomographic evaluation. Initial treatment of patients with spontaneous subarachnoid hemorrhage includes resuscitation and/or stabilization, management of acute effects of the hemorrhage, and prompt referral for neurosurgical treatment.