Last reviewed: 5 Oct 2024
Last updated: 14 Jul 2023
Summary
Definition
History and exam
Key diagnostic factors
- headache
Full details
Other diagnostic factors
- seizures
- nuchal rigidity
- decreased level of consciousness
- focal neurologic deficit
Full details
Risk factors
- smoking
- moderate- to high-level alcohol consumption
- family history of subarachnoid hemorrhage
- previous subarachnoid hemorrhage
- heritable connective tissue disease
- hypertension
- head trauma
- intracranial infection
- tumor
- arteriovenous malformations or fistulas
- drug abuse
Full details
Diagnostic tests
1st tests to order
- CT head scan
- conventional catheter-based angiogram
- CT angiography
- magnetic resonance angiography (MRA)
Full details
Tests to consider
- lumbar puncture
Full details
Treatment algorithm
ACUTE
unruptured aneurysm
ruptured aneurysm
Contributors
Authors
Brendan Eby, MD
Assistant Professor
Departments of Neurology, Neurosurgery, and Radiology
Washington University School of Medicine
St. Louis
MO
Disclosures
BE has been a paid speaker at a national neurointervention fellows course sponsored by Penumbra Inc; the talk was unrelated to the sponsor's products or services.
Acknowledgements
Dr Eby would like to gratefully acknowledge Dr Grasso and Dr Michael Chen, the previous contributors to this topic.
Disclosures
MC is an author of a reference cited in this topic.
Peer reviewers
David Altschul, MD
Chief of Neurovascular Surgery
Montefiore Medical Center
New York
NY
Disclosures
DA declares that he has no competing interests.
Peter Martin, MA, BM BCh, MD, FRCP
Consultant Neurologist
Addenbrookes Hospital
Cambridge
UK
Disclosures
PM declares that he has no competing interests.
Differentials
- Arteriovenous malformation
- Hypertensive intracerebral hemorrhage
- Cerebral venous sinus thrombosis
More DifferentialsGuidelines
- Guidelines for the management of patients with aneurysmal subarachnoid hemorrhage
- Guidelines on management of unruptured intracranial aneurysms
More GuidelinesPatient information
Emergency treatment for a stroke
More Patient information- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer