What are the typical clinical features of subarachnoid haemorrhage?
Typically patients have a sudden onset of a severe generalized headache. The headache is usually maximal at or near onset and is usually associated with vomiting, collapse and neck stiffness. Subarachnoid haemorrhage can also present with acute confusion or a focal deficit without a clear history of headache, particularly in the elderly. What is the initial management of subarachnoid haemorrhage? • The patient should have their airway, circulation and breathing assessed and be resuscitated if necessary. • The patient needs a neurological examination and careful documentation of conscious level (with the Glasgow Coma Scale) or orientation. Neurological observations should be started. • The patient needs an urgent CT scan. If this confirms the diagnosis then they need neurosurgical referral. Equivocal scans should also be discussed with the Neurosurgeons. Patients with a subarachnoid haemorrhage diagnosed on CT do not need a LP. • If the CT scan is normal the patient should have a lumbar
