0
ARTICLE |

Pitfalls in the Recognition of Subarachnoid Hemorrhage FREE

Harold P. Adams, Jr, MD; Douglas D. Jergenson, MD; Neal F. Kassell, MD; A. L. Sahs, MD
[+] Author Affiliations

Reprint requests to Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 (Dr Adams).


JAMA. 1980;244(8):794-796. doi:10.1001/jama.1980.03310080028019
Text Size: A A A
Published online

Between January 1970 and January 1978, one hundred eighty-two patients were admitted to the University of Iowa Hospitals for treatment of subarachnoid hemorrhages secondary to a ruptured aneurysm. The correct diagnosis had been delayed in 41 patients, with most treated from four to seven days before the correct diagnosis was established. Generally, these patients were initially less acutely ill than those patients whose conditions were promptly diagnosed. The most common misdiagnoses were systemic infectious illnesses, migraine headache, and hypertensive encephalopathy. Rebleeding occurred in three patients before the correct diagnosis was made. Atypical symptoms, problems in diagnosis, and the need for prompt therapy are reviewed.

(JAMA 244:794-796, 1980)

REFERENCES

Kurtzke JF:  An introduction to the epidemiology of cerebrovascular disease , in Scheinberg P (ed): Cerebral Diseases, Tenth Princeton Conference . New York, Raven Press, 1976;, pp 239-253.
Garroway WM, Whisnant JP, Furlan AJ, et al:  The declining incidence of stroke . N Engl J Med 300:449-452, 1979;.
Sundt TM, Whisnant JP:  Subarachnoid hemorrhage from intracranial aneurysm . N Engl J Med 299:116-122, 1978;.
Locksley HB:  Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage: Section V, part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations . J Neurosurg 25:321-368, 1966;.
Nibbelink DW, Torner JC, Henderson WG:  Intracranial aneurysms and subarachnoid hemorrhage—report of a randomized treatment study: IV-A. Regulated bed rest . Stroke 8:202-218, 1977;.
Nibbelink DW:  Antihypertensive and antifibrinolytic therapy following subarachnoid hemorrhage from ruptured intracranial aneurysm, Cooperative Aneurysm Study , in Whisnant JP, Sandok BA (eds): Cerebral Vascular Diseases . New York, Grune & Stratton Inc, 1975;, pp 155-165.
Nibbelink DW, Torner JC, Henderson WG:  A cooperative study: Antifibrinolytic therapy in recent onset subarachnoid hemorrhage . Stroke 6:622-629, 1975;.
Sano K, Saito I:  Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm . Acta Neurochir 41:49-60, 1978;.
Hori S, Suzuki J:  Early intracranial operations for ruptured aneurysms . Acta Neurochir 46:93-104, 1979;.
Walton JN: Subarachnoid Hemorrhage . Edinburgh, E&S Livingstone Ltd, 1956;.
Locksley HB:  Report on the Cooperative Study of Intracranial Aneurysm and Subarachnoid Hemorrhage: Section V, part I. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformation . J Neurosurg 25:219-240, 1966;.
Fisher CM:  Clinical syndromes in cerebral thrombosis, hypertensive hemorrhage and ruptured saccular aneurysm . Clin Neurosurg 22:117-147, 1975;.
Rogers DT, Garner JT, Jacques S:  Subarachnoid hemorrhage . Dis Nerv Syst 38:825-829, 1977;.
Chester EM, Agamanolis DP, Banker BQ, et al:  Hypertensive encephalopathy: A clinicopathologic study of 20 cases . Neurology 28:928-939, 1978;.
Keane JR:  Retinal hemorrhages: Its significance in 100 patients with acute encephalopathy of unknown cause . Arch Neurol 36:691-694, 1979;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Kurtzke JF:  An introduction to the epidemiology of cerebrovascular disease , in Scheinberg P (ed): Cerebral Diseases, Tenth Princeton Conference . New York, Raven Press, 1976;, pp 239-253.
Garroway WM, Whisnant JP, Furlan AJ, et al:  The declining incidence of stroke . N Engl J Med 300:449-452, 1979;.
Sundt TM, Whisnant JP:  Subarachnoid hemorrhage from intracranial aneurysm . N Engl J Med 299:116-122, 1978;.
Locksley HB:  Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage: Section V, part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations . J Neurosurg 25:321-368, 1966;.
Nibbelink DW, Torner JC, Henderson WG:  Intracranial aneurysms and subarachnoid hemorrhage—report of a randomized treatment study: IV-A. Regulated bed rest . Stroke 8:202-218, 1977;.
Nibbelink DW:  Antihypertensive and antifibrinolytic therapy following subarachnoid hemorrhage from ruptured intracranial aneurysm, Cooperative Aneurysm Study , in Whisnant JP, Sandok BA (eds): Cerebral Vascular Diseases . New York, Grune & Stratton Inc, 1975;, pp 155-165.
Nibbelink DW, Torner JC, Henderson WG:  A cooperative study: Antifibrinolytic therapy in recent onset subarachnoid hemorrhage . Stroke 6:622-629, 1975;.
Sano K, Saito I:  Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm . Acta Neurochir 41:49-60, 1978;.
Hori S, Suzuki J:  Early intracranial operations for ruptured aneurysms . Acta Neurochir 46:93-104, 1979;.
Walton JN: Subarachnoid Hemorrhage . Edinburgh, E&S Livingstone Ltd, 1956;.
Locksley HB:  Report on the Cooperative Study of Intracranial Aneurysm and Subarachnoid Hemorrhage: Section V, part I. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformation . J Neurosurg 25:219-240, 1966;.
Fisher CM:  Clinical syndromes in cerebral thrombosis, hypertensive hemorrhage and ruptured saccular aneurysm . Clin Neurosurg 22:117-147, 1975;.
Rogers DT, Garner JT, Jacques S:  Subarachnoid hemorrhage . Dis Nerv Syst 38:825-829, 1977;.
Chester EM, Agamanolis DP, Banker BQ, et al:  Hypertensive encephalopathy: A clinicopathologic study of 20 cases . Neurology 28:928-939, 1978;.
Keane JR:  Retinal hemorrhages: Its significance in 100 patients with acute encephalopathy of unknown cause . Arch Neurol 36:691-694, 1979;.
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.