| Failure to recognize spectrum of presentation of subarachnoid hemorrhage |
- Not obtaining complete history from patients with unusual (for the patient) headaches
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- Is the quality different and severity greater than prior headaches?
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- Failure to appreciate that the headache can improve spontaneously or with non-narcotic analgesics
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- Focusing on the secondary head injury resulting from syncope and fall or motor vehicle collision
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- Focusing on ECG abnormalities
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- Focusing on elevated blood pressure
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- Overreliance on the classic presentation
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- Misdiagnosis of other disorders (eg, viral syndrome, viral meningitis, migraine, tension-type headache, sinus-related headache, psychiatric disorder)
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| Failure to understand the limitations of head CT scanning |
- Sensitivity decreases as onset of headache increases
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- False-negative results with small-volume bleeds
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- Scan interpreted by inexperienced physician
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- Motion artifacts or lack of thin cuts of posterior fossa
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- False-negative results due to hematocrit of less than 30%
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| Failure to perform lumbar puncture or interpret the CSF findings correctly |
- Failure to perform lumbar puncture in patients with negative or inconclusive CT scans
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- Failure to distinguish a traumatic tap from true subarachnoid hemorrhage
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- Failure to recognize that xanthochromia may be absent very early (less than 12 hours) and very late (more than 2 weeks)
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