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• Onset of subarachnoid haemorrhage during sleep
  Jeannette Hofmeijer (MD, PhD)
  Published on: 14 April 2016

• Published on: 14 April 2016

  Onset of subarachnoid haemorrhage during sleep

  • Jeannette Hofmeijer (MD, PhD)
  • Other Contributors:
    • Rudolf H. Boerman (MD, PhD), Gabriel J.E. Rinkel

  Larner wrote an interesting article on morning headaches.1 We would like to react to the statement 'Onset of subarachnoid haemorrhage during sleep is extremely rare, if it occurs at all.' In October 2008 a 62 year old woman was seen on the emergency department. She reported moderately severe headache on awakening with chills and a slight dizziness. There was a history of ulcerative colitis and she smoked 5 cigarettes a da...

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  Larner wrote an interesting article on morning headaches.1 We would like to react to the statement 'Onset of subarachnoid haemorrhage during sleep is extremely rare, if it occurs at all.' In October 2008 a 62 year old woman was seen on the emergency department. She reported moderately severe headache on awakening with chills and a slight dizziness. There was a history of ulcerative colitis and she smoked 5 cigarettes a day. General, neurological, and laboratory examinations were unremarkable. Because of the chills a possible viral infection with headache was presumed. The patient was reassured and went home. The next morning her husband found her in bed unresponsive and took her to the emergency department urgently. She was comatose, with a Glasgow Coma Scale Score of E1M3V1, fixed dilated pupils and bilateral extensor plantar responses. CT showed a massive subarachnoid haemorrhage with intracerebral and subdural blood and CTA a middle cerebral artery aneurysm. Despite surgical decompression with clipping of the aneurysm, the patient died the next day. Our patient had an aneurysmal bleeding during sleep in two successive nights. Although aneurysmal subarachnoid haemorrhage often is considered to be triggered by strenuous activities, onset during non-strenous activities and even sleep is not rare. In a series of 141 patients, onset of SAH occurred during sleeping, resting, sitting, eating, or drinking in 38 patients ( 27%).2 In a series of 513 patients it occurred during sleeping or resting in 41 (8%),3 and in a series of 500 patients during sleep in 45 (9%).4 In conclusion, onset of subarachnoid haemorrhage during sleep is not extremely rare. Not considering aneurysmal subarachnoid haemorrhage in patients awakening with unusual headache is dangerous.

  References 1. Larner AJ. Not all morning headaches are due to brain tumours. Pract Neurol 2009;9:80-84 2. Ferro JM, Pinto AN. Sexual activity is a common precipitant of subarachnoid hemorrhage. Cerebrovasc Dis 1994;4:375 3. Matsuda M, Watanabe K, Saito A, Matsumura K, Ichikawa M. Circumstances, activities, and events precipitating aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2007;16:25-29 4. Schievink WI, Karemaker JM, Hageman LM, van der Werf DJM. Circumstances surrounding aneurysmal subarachnoid hemorrhage. Surg Neurol 1989;32:266-272

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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