Clinical presentation of patients with subarachnoid haemorrhage at a local emergency department.

AIM OF STUDY: To assess the clinical presentation of patients with spontaneous subarachnoid haemorrhage (SAH) at a local Emergency Department (ED).
METHODS: A retrospective study was conducted on the clinical presentation of patients with spontaneous SAH who presented initially to the ED of the National University Hospital, Singapore and were subsequently admitted for management over a 5-year period from January 1992 to December 1996. The cases of spontaneous SAH over the 5-year period were identified from the following sources: computer records of admitted cases of SAH, surgical intensive care unit admissions and operating theatre records.
RESULTS: Sixty-one patients [42 females (69%) and 19 males (31%)] were reviewed. Their ages ranged from 16 to 86 years with a median of 57 years. All the 61 patients had the diagnosis of SAH confirmed by either computerised tomographic (CT) scan of the head (57 patients), lumbar puncture (3 patients) or cerebral angiogram (1 patient). Thirty patients (49%) had a history of hypertension. Common presenting symptoms were headache (70%), vomiting (61%), giddiness (30%), unconsciousness (28%), syncope (26%) and fits (20%). Physical findings at the ED included elevated blood pressure (34%), neck stiffness (21%), focal weakness (13%), fever (8%) and preretinal haemorrhages (2%).
CONCLUSION: Patients with spontaneous SAH often present with classical symptoms such as headache or vomiting at the ED locally. Neck stiffness, however, is often not present at the ED.