Clinical Presentation of aSAH
Findings of a retrospective secondary analysis (Adkins, 2012) of data from two prospective studies of patients with a positive diagnosis of SAH, indicated that 83% of patients (n=160) reported headache to be the most common reason for seeking medical care followed by stiff neck (50%). Adkins et al. also found that other frequently reported symptoms included nausea (42% [n = 81]) and vomiting (43% [n = 83]), changes in LOC (32% [n = 62]).
Patient status on arrival in the Emergency Department (ED):
Other studies have found that in addition to the sudden and severe headache that accompanies the rupture of the aneurysm, a significant number of patients (27%-40%) report an intense, and persistent headache, preceding the spontaneous subarachnoid hemorrhage (SAH) by days or weeks (Pereira, 2012; Polmear, 2003).
The earlier "warning leak" headache is reflective of minor vessel rupture before the actual aneurysmal hemorrhage, and can be accompanied by nausea and vomiting, stiff neck, brief loss of consciousness, photophobia, and/or minor focal deficits. Warning leaks occur in 10-43% of patients and can last up to a few days. Despite the presence of warning leaks in some patients, the vast majority of aSAH patients are asymptomatic until aneurysm rupture and hemorrhage (Connolly et al., 2012; Polmear, 2003).
Signs and Symptoms of Hemorrhagic Stroke
Headache is the most common patient complaint associated with SAH.