• Headache
  • Sudden onset
  • Described as the "worst ever experience"
  • Can be preceded by a popping or snapping sensation in the head
  • Pain described as a new type
  • Generalized pain, often worse near the back of the head
• Nausea and vomiting may accompany the headache
• Decreased consciousness and alertness
  • Temporary or progressively worsens to coma and death
• Difficulty seeing or changes in vision
  • Double vision
  • Blind spots
  • Temporary loss of vision in one eye
• Stiff neck
• Photophobia (light bothering or hurting the eyes)
• Muscle aches (especially neck pain and shoulder pain)
• Seizure or spell
• Difficulty or loss of movement or sensation of a part of the body
• Changes in mood and personality
  • Confusion
  • Irritability

Additional symptoms that may be associated with this disease:

• Eyes, pupils different size
• Eyelid drooping
• Opisthotonos (not very common)

About 30% of patients with SAH are misdiagnosed at first. If subarachnoid hemorrhage is suspected, a computed tomography (CT) scan (without dye contrast) of the head should be immediately performed. In some cases, the head CT scan may be normal, especially if there has only been a small bleed. If the CT scan is normal, a lumbar puncture (spinal tap ) must be performed. Patients with SAH will have blood in their spinal fluid.

Cerebral angiography of blood vessels of the brain may show small aneurysms or other vascular problems. This test can pinpoint the exact location of the bleed.

A physicial exam may reveal a stiff neck due to irritated meninges (the tissues covering the brain). Movement of the neck may be resisted in all but deeply comatose people. There may also be signs of decreased nerve and brain function (focal neurologic deficit ).

An eye exam may also reveal bleeding in the brain. Decreased eye movements can indicate damage to the 3rd or 6th cranial nerve.

SAH may also alter the results of CPK isoenzymes.

Kirmani JF, Alkawi A, Ahmed S, et al. Endovascular treatment of subarachnoid hemorrhage. Neurol Res. 2005;27 Suppl 1:103-7.

Edlow JA. Diagnosis of subarachnoid hemorrhage. Neurocrit Care. 2005;2(2):99-109.

Bird S. Failure to diagnose: subarachnoid haemorrhage. Aust Fam Physician. 2005 Aug;34(8):682-3.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:2362-2363.