Symptoms of subarachnoid haemorrhage
Classical presentation is a sudden onset ‘thunderclap’ headache, often described as the ‘worst headache in the world’, commonly occipital
However, the presentation is highly variable, so any acute severe headache should lead SAH to be high on your differential diagnosis list
Nausea and vomiting (prognostically poor if happens at onset)
Meningism [neck stiffness and photophobia due to meningeal irritation] (prognostically poor)
Seizures (only in 7% but highly suggestive)
Early seizures predict late seizures and poor outcome
New neurology (prognostically poor)
Diplopia is most common
Weakness, dizziness, ptosis, dysphasia
Reduced GCS in approx 60% (prognostically poor)
Papilloedema, retinal haemorrhages or subhyaloid haemorrhage in major haemorrhage
Prognostically poor features include:
Vomiting, hypertension, loss of consciousness at presentation, meningism, new clinical neurology