Subarachnoid Haemorrhage
Bad Headaches
A thunderclap headache (TCH) has been defined as a “headache that reaches 7 (out of 10) or more in intensity within less than one minute.”
CT for Subarachnoid Hemorrhage
A negative head CT in a neurologically normal patient, with a thunderclap headache presentation, a clear time of onset, and a modern CT scanner performed within 6 hours of onset read by an attending radiologist results in a post test risk of SAH of 1 – 2/1000 patients. A shared decision strategy should be used to balance the risk and benefits of performing a lumbar puncture versus a negative CT within 6 hours being sufficient to rule out SAH.
A Thunderclap Headache
A thunderclap headache is defined as a very severe headache that reaches its maximum intensity within 1 minute. One of the most common causes is subarachnoid hemorrhage, but what else can cause a it?
Subarachnoid Hemorrhage
Never ignore a headache that’s ‘different’, ‘never felt before’, ‘worst’ or not subsiding with ‘usual’ medicines…get a non-contrast CT Head
Serious reasons why your patient fainted…
If your patient presents with…
- Symptoms of arm ischemia or paresthesias with syncope – Subclavian steal syndrome
- Chest pain that is acute, radiates, tearing/sharp, involves symptoms above and below diaphragm with syncope – Aortic dissection
- Tachypnea, pleuritic chest pain, shortness of breath with syncope – PE
- Neurologic deficit with syncope – TIA/stroke
- Headache that is sudden in onset, maximal at onset, worst of life with syncope – Subarachnoid hemorrhage
- Minor trauma with head or neck pain and syncope – Carotid/vertebral artery dissection
- Abdominal/flank pain in older patient with syncope – Ruptured AAA
