Q: Relatively, which of the following is more common in Subarachnoid hemorrhage (SAH)? - select one
A) loss of consciousness (LOC)
B) vomiting
C) neck pain or stiffness
D) seizure
Answer: C
Conventionally, all academic books describe SAH classically as the 'worst headache of life.' It's very true! However, two-thirds of patients report neck pain or stiffness. Vomiting is also very common, but LOC is reported only by one in ten patients. Seizures are less common, but they are a poor prognostic sign if they occur.
One important differential diagnosis is meningismus, which is more associated with lower back pain.
#neurology
References:
1. Perry JJ, Sivilotti MLA, Sutherland J, et al. Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. CMAJ 2017; 189:E1379.
2. Claassen J, Park S. Spontaneous subarachnoid haemorrhage. Lancet 2022; 400:846.
3. Butzkueven H, Evans AH, Pitman A, et al. Onset seizures independently predict poor outcome after subarachnoid hemorrhage. Neurology 2000; 55:1315.
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