Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be talking to you about subarachnoid hemorrhage.

And you can follow along with written notes on this topic at zero to finals.com slash subarachnoid hemorrhage or in the neurology section of the zero to finals medicine book.

So let's get straight into it.

Subarachnoid hemorrhage involves bleeding into the subroachnoid space where the cerebral spinal

fluid is located and this is between the pyamata and the arachnoid membrane.

And this is usually the result of a ruptured cerebral artery aneurysm.

Subarachnoid hemorrhage has a very high mortality and morbidity.

Therefore it's very important not to miss the diagnosis and you need to have a low suspicion

to trigger full investigations.

It needs to be discussed with the neurosurgical

unit with a view to doing surgical intervention. Let's talk about the presenting feature,

which is typically something called a thunder clap headache. And the typical history is of a sudden

onset occipital headache, so a sudden onset headache at the back

of the head that occurs during some sort of strenuous activity like lifting weights or having

sexual intercourse. And this occurs so suddenly and severely it's known as a thunder clap headache.

It's described like being hit really hard at the back of your head

unexpectedly. Other features are neck stiffness, photophobia and neurological symptoms like

visual changes, speech changes, weakness, seizures and loss of consciousness. There's a few

risk factors to be aware of, high blood pressure,

smoking, excessive alcohol consumption, cocaine use and a family history. It's also more common

in black patients, female patients and patients aged 45 to 70. There's particular associations it's worth

being aware of for your exams and these are cocaine use, sickle cell anemia, so patients with

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