Signs and Symptoms Before and During SAH

Often, the initial signs SAH are ignored and/or attributed to other causes. For example, a first migraine headache may be due to aneurysmal bleeding. A minor bleed may produce a severe headache with a sudden onset, neck pain, nausea and vomiting, photophobia (sensitivity to light), or combinations of symptoms. Localized head pain, cranial nerve palsies, or visual abnormalities due to pressure on cranial nerves III, IV, and VI may signal aneurysmal expansion.

Aneurysmal rupture often occurs during physical exertion or strenuous activity, such as heavy lifting, physical exercise, sexual activity, or straining during defecation. Recent evidence also indicates that the extremely rapid rise in systolic blood pressure that occurs with cocaine use may cause an aneurysmal rupture in a person with a weakened cerebral vessel.

Signs of Meningitis

Kernig's Sign
Brudzinski's Sign
With patient supine:
* flex hip 90 degrees
* flex knee 90 degrees
* try to extend the lower leg    while keeping hip flexed
With patient supine:
*verify cervical spine intact
*place hands behind neck  and gently elevate head  toward chest.
Pain or resistance, absent history of cancer or back injury, is suggestive of meningitis. Hips and knees will flex in response to neck flexion.
Kernig's sign can be elicited within minutes of SAH. Brudzinski"s sign may be elicited within minutes of SAH.

When a cerebral aneurysm ruptures, blood flows into the subarachnoid space. Blood is very irritating to meninges. The irritation produces nuchal rigidity, nausea, vomiting, blurred vision, photophobia, and a sudden violent headache, often described by the patient as "the worst headache of my life." Meningeal irritation (meningitis) can be reliably demonstrated by positive Kernig's or Brudzinski's sign.

SAH rarely occurs in the absence of headache. Suspicion of SAH should be high in a patient who experiences a severe headache followed by a transient loss of consciousness. Stroke symptoms, including hemiparesis, (one-sided weakness) hemiplegia, (one-sided paralysis) aphasia, (difficulty in speaking or inability to speak) or cognitive deficits may be observed, depending on the part of the brain that is deprived of its blood supply.

Seizures, hypertension, bradycardia, and a widening pulse pressure signal increasing intracranial pressure and the development of cerebral edema, or swelling of the brain. As the pituitary gland is located near the site of a majority of aneurysmal ruptures, symptoms of pituitary dysfunction, such as syndrome of inappropriate anti-diuretic hormone secretion (SIADH), or diabetes insipidus may occur during the clinical course.

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Warning signs of a cerebral aneurysm are frequently ignored or mistaken for other problems.

Jill Bolte Taylor a neurophysiologist shares her personal SAH experience on