Case history
Case history
A 53-year-old black woman presents with a sudden, excruciating headache which started while sitting at work. The headache is diffuse, intense, and accompanied by nausea and vomiting. She describes the headache as the worst headache of her life. She loses consciousness following onset of the headache and is on the floor for less than 1 minute. She is being treated for hypertension and is a smoker. On examination she has a normal mental state, meningismus, bilateral subhyaloid haemorrhages, and right third cranial nerve palsy. There are no sensory deficits or weakness. Brain computed tomography (CT) reveals diffuse subarachnoid blood in basal cisterns and sulci.
Other presentations
An atypical presentation of subarachnoid haemorrhage (SAH) includes less severe headaches, headaches accompanied by vomiting and low-grade fever, and prominent neck pain. Around 15% to 60% of patients with spontaneous SAH experience sentinel headaches.[2] Some of these headaches are caused by minor leaks from the aneurysm, which CT is unreliable in detecting.[3] Patients who experience sentinel headache might have an increased risk of rebleeding.[2][4]
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