Education and debate

Lesson of the Week: Subarachnoid haemorrhage presenting as head injury

^a Walsgrave Hospital, Coventry CV2 2DX, ^b North Staffordshire Royal Infirmary, Stoke on Trent ST4 7NL

Correspondence to: Mr D E Sakas, Midland Centre for Neurosurgery and Neurology, Smethwick, Warley, West Midlands B67 7JX.

Headache, nausea, vomiting, and transient loss of consciousness occur in two thirds of people who experience subarachnoid haemorrhage.¹ Loss of consciousness may result in an abrupt fall and trauma to the head immediately after the haemorrhage. The distinction between subarachnoid haemorrhage and head injury may therefore be blurred sometimes, with the spontaneous subarachnoid haemorrhage remaining unrecognised. We believe that this clinical problem has not been properly addressed. We report on four patients with head injury, in whom a spontaneous subarachnoid haemorrhage preceded the trauma, and suggest guidelines for investigating and managing such patients.

Case reports

CASE 1

A 45 year old man became unconscious after he fell 6 m from scaffolding. On admission he was convulsing, with pupils of equal size and reacting to light. He had a laceration of the scalp and an orbital fracture. Computed . . . [Full text of this article]

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Relevant Article

Pitfalls in the diagnosis of subarachnoid haemorrhage

Fergus Coakley, Nick Messios, Bruno Morgan, and Richard Owen
BMJ 1995 311: 871-872. [Extract] [Full Text]

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