Aneurysmal subarachnoid hemorrhage (SAH) presents at a mean age of 55 years and affected patients are more likely to be Black, female, or tobacco users or have hypertension. Although patients rarely have a family history of cerebral aneurysm, two or more first-degree relatives with the condition confers a 12% prevalence of cerebral aneurysm. The American Heart Association (AHA) and American Stroke Association (ASA) released guidelines for the management of patients with aneurysmal SAH.

DIAGNOSING ANEURYSMAL SAH

Classically, aneurysmal SAH presents with sudden-onset headache that immediately reaches its maximum intensity. Warning or sentinel headaches precede up to 43% of these hemorrhages. Aneurysmal SAH can be ruled out in alert patients 15 years or older with sudden-onset nontraumatic headache that reaches maximum intensity within 1 hour, and who have none of the signs or symptoms listed in the Ottawa SAH rule: age 40 years or older, neck pain or stiffness, witnessed loss of consciousness, onset during exertion, thunderclap headache, or limited neck flexion on examination.