Acute & emergency · UKMLA & AKT
Subarachnoid haemorrhage
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Thunderclap headache - sudden onset, maximal intensity within 1-5 minutes, often occipital; 'worst headache of my life' / 'like a blow to the back of the head'
- Meningism - neck stiffness, photophobia, phonophobia (blood irritates meninges; may take hours to develop)
- Nausea and vomiting - raised ICP
- Transient loss of consciousness - sudden ICP surge at rupture
- Third nerve palsy - ptosis, dilated pupil, 'down and out' eye; from posterior communicating artery aneurysm
A thunderclap headache in a migraine sufferer who says 'this is different' is SAH until proven otherwise. ADPKD is the classic genetic risk factor - berry aneurysm in ~1 in 10 patients.
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