Subarachnoid haemorrhage

doi:10.1136/bmj.b2874

Published 21 August 2009, doi:10.1136/bmj.b2874
Cite this as: BMJ 2009;339:b2874

Practice

Easily missed?

Subarachnoid haemorrhage

Graeme J Hankey, consultant neurologist and head of stroke unit, clinical professor¹^,2, Mark R Nelson, chair of general practice, professorial fellow³^,4

¹ Department of Neurology, Royal Perth Hospital, Perth, WA6001, Australia, ² School of Medicine & Pharmacology, University of Western Australia, Perth, ³ School of Medicine, University of Tasmania, Hobart, Tasmania , ⁴ Menzies Research Institute, University of Tasmania, Hobart, Tasmania

Correspondence to: G J Hankey gjhankey@cyllene.uwa.edu.au

The first 150 words of the full text of this article appear below.

Spontaneous (non-traumatic) subarachnoid haemorrhage accountsfor about 5% of strokes and often occurs at a fairly young age.The usual cause is a ruptured intracranial aneurysm.

A 45 year old woman, well known to you as shefrequently attends with migraine, has secured an appointmentat the end of your Friday list. She reports her "worst migraineever" and on specific questioning reports a sudden onset occipitalheadache now generalised with associated vomiting. She requestsanalgesia and an antiemetic so that she can "sleep it off athome" and has brought her son to drive her home.

The incidence of subarachnoid haemorrhageis about 7 per 100 000 person years¹
On average a full timegeneral practitioner with a list of 2000 patients will see onepatient with the condition every seven years
Subarachnoid haemorrhageis missed in 20-50% of patients at first presentation²