Subarachnoid Hemorrhage Causes Mnemonic: “BATS”

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Subarachnoid Hemorrhage Causes Mnemonic

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.” 😬

We’re talking about subarachnoid hemorrhage (SAH) — a diagnosis you must not miss. It’s 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 — 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 🚨
A AV Malformation / ADPKD AVMs are congenital; polycystic kidneys come with bonus cerebral aneurysms (thank you, genetics)🧬
T Trauma The classic: fall, assault, RTA. Sometimes, ā€œhit with a batā€ is not just metaphorical šŸ
S Stroke (Hemorrhagic) Rare but possible. Hypertensive bleeds can leak into subarachnoid space — don’t rule it out šŸ“‰

 

šŸ„ 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€œjust a bad headache.ā€

Ten minutes later: vomiting, photophobia, neck stiffness. CT brain? Boom — diffuse subarachnoid blood, likely from a ruptured berry aneurysm.

Cue: neurosurgery consult, nimodipine drip, and about seven worried relatives asking, ā€œIsko nazar tou nahi lag gayi?ā€ šŸ˜“

🧾 Quick Clinical Pearls from the CCU (a.k.a. The Real School)

  • CT Brain is your best friend — 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 — mandatory, not optional.
  • Always screen for PCKD if you’ve 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.
  • Don’t dismiss trauma — even mild head injuries in elderly or anticoagulated patients can leak into the subarachnoid space quietly.
  • Be mindful: SAH can mimic meningitis — photophobia, neck stiffness, low-grade fever — but lumbar puncture timing matters.

Happy learning, folks! šŸ™‚

Author: Dr. Aurangzaib Qambrani
Qualifications: MBBS, PLAB, MRCP-UK
Hospital: Sheikh Khalifa Bin Zayed Hospital, Quetta

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