Transcript
Announcer:
Welcome to NeuroFrontiers on ReachMD. On this episode, we’re joined by Dr. Jay Max Findlay, who’s a Professor of Neurosurgery at the University of Alberta. He’ll be sharing early recognition strategies for subarachnoid hemorrhage. Let’s hear from Dr. Findlay now.
Dr. Findlay:
The most important thing is the onset—the suddenness of the headache. Subarachnoid hemorrhage presents with what we have called a thunderclap headache. It's an instantaneous, very severe generalized headache, and many patients are left obtunded or unconscious following that headache.
The dangerous patients are the ones that remain relatively alert following their thunderclap headache. The reason is that anybody who has a sudden terrible headache and is obtunded or whose level of consciousness is impaired is going to get a CT scan. The dangerous patient is the one who remains awake and alert, because they may not get a CT scan, and that's how the diagnosis can be missed.
Most patients are seen first in the emergency department by what we call a casualty officer or an emergency room doctor. So they're the front line. They're going to be the first person the patient is going to see, and so they're the ones that have to be thinking about, could this be a subarachnoid hemorrhage? And so as long as they're always thinking about it—and again, it's that suddenness of onset that is the most essential feature—then they will make the diagnosis. They will get a CT scan.
It always starts with a CT head, and the patient who remains awake after their subarachnoid hemorrhage they tend to have a milder type of hemorrhage. So anybody with a massive hemorrhage is going to have a wildly abnormal CT scan. If somebody's got a much smaller hemorrhage, a milder hemorrhage, then there is a chance for it to be missed if the scan isn't reviewed by a physician with a practiced eye in looking for the subarachnoid hemorrhage, knowing where on the scan to look, where the aneurysms are located. So they need to know where to look and what to look for.
Announcer:
That was Dr. Jay Max Findlay talking about how we can better recognize subarachnoid hemorrhage. To access this and other episodes in our series, visit NeuroFrontiers on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
