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Posted on 12th May 2017

Misdiagnosis of subarachnoid haemorrhage

What is it

A subarachnoid Haemorrhage or bleed on the brain is a type of stroke which is uncommon but a very serious medical condition, in some cases it can be fatal. The NHS choices website states that a subarachnoid Haemorrhage accounts for one in every twenty (5%) of all strokes in the UK.

Symptoms

It often displays with similar symptoms to Migranes or other medical conditions and the common signs of this life threatening condition are:

  • Stiffness in your neck
  • A sudden severe headache
  • Blurred or double vision
  • Feeling sick and being sick
  • Light sensitivity

But in addition to the above, a Subarachnoid Haemorrhage can also present with:

  • Slurred speech
  • Weakness on one side
  • Loss of consciousness or convulsions

If a patient attends their GP because of an acute headache, the GP should always consider a subarachnoid haemorrhage. A GP should look at the history of the patient and if it is found that there is a history of severe headaches that come on quickly, the patient should always be admitted to Hospital to rule out this condition.

GPs often use a system of “red flags” to pinpoint medical conditions and in the case of a subarachnoid haemorrhage a GP should look for the following points when making a diagnosis.

  • Age of patient is over 50
  • Sudden onset of headaches
  • Increased severity or frequency of headaches
  • Presence of previous head trauma
  • Other medical conditions
  • Loss of consciousness
  • Meningism (inflammation of the membranes covering the central nervous system)
  • Sepsis
  • Vomiting

 SAH Graph

The age of the patient is one key factor in diagnosis because younger people tend to have migraines whereas if an older person attends their GP with sudden onset of severe headaches, GPs must seriously consider a subarachnoid haemorrhage.

What causes it

Most commonly a subarachnoid haemorrhage is caused by a week blood vessel wall which causes a bulge. In turn the weakness causes the blood vessel to burst (aneurism). It is reported that a brain aneurism happens every 18 minutes and around 40% of those are fatal. About 15% of patients die before reaching hospital.

Other causes include head trauma but this is a different type of subarachnoid haemorrhage called a Traumatic Subarachnoid Haemorrhage”

Diagnosis and misdiagnosis

GPs misdiagnose subarachnoid haemorrhage as migraines which causes a delay in receiving treatment. In some instances this delay in receiving treatment can cause long term complications or even death. It is important that immediate admission to hospital occurs.

When admitted to hospital, a patient should undergo a CT scan to establish if there is any bleeding around the brain. In some occasions a CT scan won’t pick up the bleed so the consultant may want to perform a lumbar puncture to draw some fluid from the patient’s spine so it can be analysed.

Big bore CT Scanner

Complications

When a subarachnoid haemorrhage occurs, it can cause a variety of complications both long and short term. A short term complication includes further bleeding and brain damage because the blood flow to part of the brain is reduced.

Longer term complications include epilepsy, memory problems, depression and mood changes.

Recovery

NHS UK state “around half of all cases are fatal and people who do survive can be left with long term problems including extreme tiredness, headaches and sleeping problems”

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