Subarachnoid Hemorrhage

Most subarachnoid hemorrhages (SAHs) are caused by a ruptured berry aneurysm. The patient with SAH will describe the "worst headache of my life.'' Other causes of SAH include arteriovascular malformations, bleeding disorders, and miscellaneous or cryptogenic causes. A berry aneurysm results from a congenital weakness in the arterial wall, usually occurring in the vessels of the circle of Willis and at these vessels' bifurcations. Frequently, patients are drowsy, may vomit, and have meningeal signs on physical exam. If SAH is being considered, an unenhanced CT scan should be performed and immediate neurosurgical consultation should be provided. A four-vessel cerebral angiogram is usually the next stage of the workup and serves as a road map for surgical intervention.

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