There are few phrases in medicine that immediately tighten the sphincters of both the clinician and the patient quite like “sudden onset worst headache of life.” š¬
Weāre talking about subarachnoid hemorrhage (SAH) ā a diagnosis you must not miss. Itās dramatic, dangerous, and about as subtle as a cricket bat to the skull (which, funnily enough, is one of the causes).
So how do you remember the main culprits?
Let me introduce you to the BATS mnemonic ā a fitting acronym for a condition that often strikes suddenly out of nowhere like a bat in a dark alley.
Subarachnoid Hemorrhage Causes Mnemonic: “BATS”
| Letter | Cause | Clinical Clues / Commentary |
|---|---|---|
| B | Berry Aneurysm | Most common non-traumatic cause. Think anterior communicating artery. Rupture = thunderclap šØ |
| A | AV Malformation / ADPKD | AVMs are congenital; polycystic kidneys come with bonus cerebral aneurysms (thank you, genetics)š§¬ |
| T | Trauma | The classic: fall, assault, RTA. Sometimes, āhit with a batā is not just metaphorical š |
| S | Stroke (Hemorrhagic) | Rare but possible. Hypertensive bleeds can leak into subarachnoid space ā donāt rule it out š |
š„ Scene from the Ward: The Washuk Wake-Up Call
I still remember a middle-aged schoolteacher from Washuk who walked into the ED looking relatively okay ā ājust a bad headache.ā
Ten minutes later: vomiting, photophobia, neck stiffness. CT brain? Boom ā diffuse subarachnoid blood, likely from a ruptured berry aneurysm.
Cue: neurosurgery consult, nimodipine drip, and about seven worried relatives asking, āIsko nazar tou nahi lag gayi?ā š
š§¾ Quick Clinical Pearls from the CCU (a.k.a. The Real School)
- CT Brain is your best friend ā within 6 hours, it picks up 95% of SAH cases. After that, LP for xanthochromia (yes, the dreaded spinal tap).
- Nimodipine 60 mg Q4H for vasospasm prophylaxis ā mandatory, not optional.
- Always screen for PCKD if youāve got young patients with unexplained SAH and a family history of kidney issues. Shout-out to Dr. Imran Baloch who caught this in a 36-year-old from Dera Bugti.
- Donāt dismiss trauma ā even mild head injuries in elderly or anticoagulated patients can leak into the subarachnoid space quietly.
- Be mindful: SAH can mimic meningitis ā photophobia, neck stiffness, low-grade fever ā but lumbar puncture timing matters.
Happy learning, folks! š
Author: Dr. Aurangzaib Qambrani
Qualifications: MBBS, PLAB, MRCP-UK
Hospital: Sheikh Khalifa Bin Zayed Hospital, Quetta
