Which symptom is most characteristic of a subarachnoid hemorrhage?

• A. Thunderclap headache with rapid loss of consciousness
• B. Gradual onset of weakness
• C. Nausea and vomiting without headache
• D. Chest pain radiating to the left arm

Answer: (A)

Subarachnoid hemorrhage is best recognized by a sudden, severe headache that reaches maximum intensity in seconds—a thunderclap headache—often with rapid loss of consciousness. This abrupt, intense pain comes from bleeding into the space around the brain and irritation of the meninges, which is the hallmark of SAH. Nausea and vomiting can occur but usually in the context of that sudden headache, while a gradual onset of weakness points to other problems like a stroke from a clot or other conditions. Chest pain radiating to the arm hints at a heart problem rather than a brain bleed. In the field, presenting with a thunderclap headache should prompt immediate evaluation and rapid transport to a facility capable of stroke and aneurysm workup.