Feature Article

Cerebral aneurysms and subarachnoid haemorrhage: avoiding the diagnostic pitfalls

Nicholas Little, Heath French



Patients with atypical or mild symptoms of subarachnoid haemorrhage due to a ruptured cerebral aneurysm are more difficult to diagnose than patients who present with typical symptoms of sudden severe headache and associated symptoms. Patients without typical symptoms are more likely to have low volume haemorrhages that may not be seen on a CT scan.

Key Points

  • Subarachnoid haemorrhage (SAH) due to a ruptured cerebral aneurysm is a potentially fatal condition that often presents as headache.
  • A raised index of suspicion must exist for all patients with sudden, severe headache with or without associated symptoms.
  • Initial investigation of suspected SAH should be a noncontrast CT scan; most haemorrhages will be apparent on this test.
  • Management of SAH is increasingly becoming endovascular.
  • The outcome for patients with no or only a mild global or focal neurological deficit on presentation has improved, but prehospital mortality and disability from the initial haemorrhage remains a significant problem.
  • Unruptured asymptomatic aneurysms are not an urgent scenario and can be dealt with in consultative outpatient fashion.

    Picture credit: © KO Studios