Subarachnoid Haemorrhage: A Systematic Review

Abstract

Subarachnoid haemorrhage arises from the accumulation of blood between the arachnoid and pia mater resulting from an aneurysmal rupture or traumatic head injury. Subarachnoid haemorrhage is a life-threatening emergency that requires prompt treatment. The characteristic presenting symptom is the thunderclap headache, which patients may describe as the “worst headache of life” and may prompt further imaging. Associated symptoms include nausea, vomiting, and diplopia. Often signs of meningismus are present due to the presence of blood in the fourth ventricle and further down the spinal cord, causing neck and back pain. Findings of focal deficit increase the grade of subarachnoid haemorrhage and patients with a high-grade subarachnoid haemorrhage report to the Emergency room in a state of coma requiring evaluation and urgent treatment, as the coma can be reversible. Sometimes concurrent intraocular haemorrhage, known as Terson syndrome may be present warranting an ophthalmology service. Eighty per cent of patients that develop Terson syndrome require regular follow-up visits but may not require further intervention. This activity reviews the evaluation and management of subarachnoid haemorrhage (SAH).