Intended for healthcare professionals

Rapid response to:

Clinical Review

Subarachnoid haemorrhage

BMJ 2006; 333 doi: (Published 27 July 2006) Cite this as: BMJ 2006;333:235

Rapid Response:

Unanswered clinical questions

Al Shahi et al recommend 'that cases (suspected subarachoid
haemorrhage [SAH]
patients) should at least be discussed with a specialist at a neuroscience
before the procedure (lumbar puncture)'. Do the neurologists or
really want to be burdened by consults before every lumbar puncture for
patients with CT-negative severe headaches?

The article also fails to provide any guidance on patient selection
for neuro-
intervention. In our experience, which may not be exclusive, there appears
to be
much variability in the acceptance criteria. Although the World Federation
Neurological Surgeons (WFNS) grading scale is potentially useful for
selection, a recent observational study showed that only 60% of patients
admitted to a neurosurgical centre with SAH fell into WFNS grade I and II
implying that the WFNS scale was not the only defining criteria for
for neuro-intervention. Would the authors clarify their acceptance
criteria for

1. Gnanalingham KK, Apostolopoulos V, Barazi S, O'Neill K. The impact
of the
international subarachnoid aneurysm trial (ISAT) on the management of
aneurysmal subarachnoid haemorrhage in a neurosurgical unit in the UK.
Neurol Neurosurg 2006; 108: 115-6.

Competing interests:
None declared

Competing interests: No competing interests

29 July 2006
Indran Davagnanam
SpR Radiology
Hoong Sern Lim
University Hospitals Birmingham