The following symptoms and complaints may indicate subarachnoid hemorrhage (SAB):
Leading symptoms
- Acute annihilation headache (primary thunderclap headache) – sudden onset, very severe headache that reaches peak pain within the first 60 seconds; caveat: SABs can also present with headaches that are not as severe or develop slowly
- Meningismus (painful neck stiffness).
Other symptoms
- Signs of increased intracranial pressure (ICP; intracranial pressure) such as nausea (nausea), vomiting (vomiting), decreased vigilance (alertness), somnolence (clouding of consciousness)
- Epileptic seizures (convulsions).
- Neurological deficits
- Vegetative symptoms: Drop in blood pressure, altered respiratory and pulse rates.
- Vitreous hemorrhage
- Pain in the thorax (chest), spine or even legs/restricted mobility of the cervical spine (C-spine).
Warning signs (red flags)
- Warning hemorrhage – Occurs in about 25% of patients with severe subarachnoid hemorrhage and is manifested by very severe headache and neck pain that occur days to weeks before the actual SAB. The headache and neck pain then progress to a persistent condition. The opportunity lies in recognizing these warning hemorrhages and then already being able to initiate efficient treatment for the patient, thus avoiding greater damage.