Skip to main content
SpringerLink
Log in

Systematic Approach for Diagnosis of Aneurysmal Subarachnoid Hemorrhage

  • Chapter
  • First Online:
Management of Subarachnoid Hemorrhage

  • 1089 Accesses

Abstract

Although aneurysmal subarachnoid hemorrhage (aSAH) represents a small percentage of hemorrhagic strokes, it is associated with severe devastating complications that carry high morbidity and mortality rates. Early recognition and intervention are vital to improve the outcome of these patients. However, clinicians especially emergency doctors face many challenges to timely diagnose aSAH. Emergency doctors should have high index of suspicion as well as a cautious approach to evaluate patients who present with headache which is the chief complain of aSAH. In this chapter we discuss a systematic approach to diagnose and assessment of aSAH. It describes the importance of detailed history, clinical examination, diagnostic work up, and limitations of diagnostic investigations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G, et al. European stroke organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35(2):93–112.

    Article  Google Scholar 

  2. Simpson VM. Diagnosis and initial managment of subarachnoid hemorrhage. OA Emergency Medicine. 2013;1:1–11.

    Google Scholar 

  3. Fontanarosa PB. Recognition of subarachnoid hemorrhage. Ann Emerg Med. 1989;18(11):1199–205.

    Article  CAS  Google Scholar 

  4. Marcolini E, Hine J. Approach to the diagnosis and Management of Subarachnoid Hemorrhage. West J Emerg Med. 2019;20(2):203–11.

    Article  Google Scholar 

  5. Aisiku I, Edlow JA, Goldstein J, Thomas LE. An evidence-based approach to diagnosis and management of subarachnoid hemorrhage in the emergency department. Emerg Med Pract. 2014;16(10):1–29. quiz -30

    PubMed  Google Scholar 

  6. Cohen-Gadol AA, Bohnstedt BN. Recognition and evaluation of nontraumatic subarachnoid hemorrhage and ruptured cerebral aneurysm. Am Fam Physician. 2013;88(7):451–6.

    PubMed  Google Scholar 

  7. Perry JJ, Stiell IG, Sivilotti ML, Bullard MJ, Lee JS, Eisenhauer M, et al. High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ. 2010;341:c5204.

    Article  Google Scholar 

  8. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012;43(6):1711–37.

    Article  Google Scholar 

  9. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke. 2009;40(3):994–1025.

    Article  Google Scholar 

  10. Ahmed AE, Ganaw AMT, Mohamed AO, Khair B. Aneurysmal subarachnoid hemorrhage. ICU book, Intechopen; 2017. p. 73–99.

    Google Scholar 

  11. Edlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med. 2000;342(1):29–36.

    Article  CAS  Google Scholar 

  12. Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. American College of Emergency P. clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008;52(4):407–36.

    Article  Google Scholar 

  13. Yu DW, Jung YJ, Choi BY, Chang CH. Subarachnoid hemorrhage with negative baseline digital subtraction angiography: is repeat digital subtraction angiography necessary? J Cerebrovasc Endovasc Neurosurg. 2012;14(3):210–5.

    Article  Google Scholar 

  14. Kwon HM, Baek JW, Lee SP, Cho JI. A fatal adverse effect of barbiturate coma therapy: Dyskalemia. Korean J Neurotrauma. 2016;12(2):156–8.

    Article  Google Scholar 

  15. O’Neill J, McLaggan S, Gibson R. Acute headache and subarachnoid haemorrhage: a retrospective review of CT and lumbar puncture findings. Scott Med J. 2005;50(4):151–3.

    Article  Google Scholar 

  16. Sidman R, Connolly E, Lemke T. Subarachnoid hemorrhage diagnosis: lumbar puncture is still needed when the computed tomography scan is normal. Acad Emerg Med. 1996;3(9):827–31.

    Article  CAS  Google Scholar 

  17. Perry JJ, Spacek A, Forbes M, Wells GA, Mortensen M, Symington C, et al. Is the combination of negative computed tomography result and negative lumbar puncture result sufficient to rule out subarachnoid hemorrhage? Ann Emerg Med. 2008;51(6):707–13.

    Article  Google Scholar 

  18. van der Wee N, Rinkel GJ, Hasan D, van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry. 1995;58(3):357–9.

    Article  Google Scholar 

  19. Buruma OJ, Janson HL, Den Bergh FA, Bots GT. Blood-stained cerebrospinal fluid: traumatic puncture or haemorrhage? J Neurol Neurosurg Psychiatry. 1981;44(2):144–7.

    Article  CAS  Google Scholar 

  20. Quattrone A, Bono F, Oliveri RL, Gambardella A, Pirritano D, Labate A, et al. Cerebral venous thrombosis and isolated intracranial hypertension without papilledema in CDH. Neurology. 2001;57(1):31–6.

    Article  CAS  Google Scholar 

  21. McKinney AM, Palmer CS, Truwit CL, Karagulle A, Teksam M. Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography. AJNR Am J Neuroradiol. 2008;29(3):594–602.

    Article  CAS  Google Scholar 

  22. McCormack RF, Hutson A. Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan? Acad Emerg Med. 2010;17(4):444–51.

    Article  Google Scholar 

  23. Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355(9):928–39.

    Article  CAS  Google Scholar 

  24. Park SH, Lee CY. Supraclinoid internal carotid artery fenestration harboring an unruptured aneurysm and another remote ruptured aneurysm: case report and review of the literature. J Cerebrovasc Endovasc Neurosurg. 2012;14(4):295–9.

    Google Scholar 

  25. Yuan MK, Lai PH, Chen JY, Hsu SS, Liang HL, Yeh LR, et al. Detection of subarachnoid hemorrhage at acute and subacute/chronic stages: comparison of four magnetic resonance imaging pulse sequences and computed tomography. J Chin Med Assoc. 2005;68(3):131–7.

    Article  Google Scholar 

  26. Brown SC, Brew S, Madigan J. Diagnosis of suspected subarachnoid hemorrhage in adults. Praxis (Bern 1994). 2011;100(24):1493–7.

    Article  CAS  Google Scholar 

  27. Agid R, Lee SK, Willinsky RA, Farb RI. terBrugge KG. Acute subarachnoid hemorrhage: using 64-slice multidetector CT angiography to “triage” patients’ treatment. Neuroradiology. 2006;48(11):787–94.

    Article  CAS  Google Scholar 

  28. Kaufmann TJ, Huston J 3rd, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF. Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology. 2007;243(3):812–9.

    Article  Google Scholar 

  29. Wang H, Li W, He H, Luo L, Chen C, Guo Y. 320-detector row CT angiography for detection and evaluation of intracranial aneurysms: comparison with conventional digital subtraction angiography. Clin Radiol. 2013;68(1):e15–20.

    Article  CAS  Google Scholar 

  30. Fu FW, Rao J, Zheng YY, Song L, Chen W, Zhou QH, et al. Perimesencephalic nonaneurysmal subarachnoid hemorrhage caused by transverse sinus thrombosis: a case report and review of literature. Medicine (Baltimore). 2017;96(33):e7374.

    Article  Google Scholar 

  31. Zheng SF, Yao PS, Yu LH, Kang DZ. Keyhole approach combined with external ventricular drainage for ruptured, poor-grade, anterior circulation cerebral aneurysms. Medicine (Baltimore). 2015;94(51):e2307.

    Article  Google Scholar 

Download references

Acknowledgements

Thanks are extended to Dr.Nezar Alsharef O Shlaka.

Author information

Authors and Affiliations

  1. Anesthesia, Perioperative Medicine and Critical Care Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

    Adel E. Ahmed Ganaw, Moad Ehfeda, Nissar Shaikh, Marcus Lance & Ali O. Mohamed Bel Khair

  2. Radiology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

    Abdussalam Abugrara

  3. Neurosurgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

    Sirajeddin Belkhair

  4. Neurosurgery Department, Weill Cornell Medical College, Doha, Qatar

    Sirajeddin Belkhair

  5. Neurosurgery Department, Michigan State University, East Lansing, MI, USA

    Sirajeddin Belkhair

Authors
  1. Adel E. Ahmed Ganaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moad Ehfeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nissar Shaikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcus Lance
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abdussalam Abugrara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali O. Mohamed Bel Khair
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sirajeddin Belkhair
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adel E. Ahmed Ganaw .

Editor information

Editors and Affiliations

  1. Anesthesia, Perioperative Medicine and Critical Care Department, Hamad General Hospital Hamad Medical Corporation, Doha, Qatar

    Adel E. Ahmed Ganaw

  2. Department of Anesthesia Perioperative Medicine and Critical Care, Surgical Intensive Care Unit Hamad Medical Corporation, Doha, Qatar

    Nissar Shaikh

  3. Faculty of Medicine, Tanta University, Tanta, Egypt

    Nabil A. Shallik

  4. Department of Anesthesiology, University of Muenster, Muenster, Germany

    Marco Abraham E. Marcus

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ganaw, A.E.A. et al. (2022). Systematic Approach for Diagnosis of Aneurysmal Subarachnoid Hemorrhage. In: Ganaw, A.E.A., Shaikh, N., Shallik, N.A., Marcus, M.A.E. (eds) Management of Subarachnoid Hemorrhage. Springer, Cham. https://doi.org/10.1007/978-3-030-81333-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81333-8_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81332-1

  • Online ISBN: 978-3-030-81333-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation