Critical Care Registered Nurse (CCRN) Practice Exam

Which symptom is most commonly associated with an aneurysmal subarachnoid hemorrhage?

1. Progressive dizziness

2. Thunderclap headache

3. Localized seizures

4. Visual disturbances

The correct answer is: Thunderclap headache

A thunderclap headache is a sudden, severe headache that often occurs at the onset of an aneurysmal subarachnoid hemorrhage (SAH). This type of headache is classically described as the worst headache of one's life and is due to the abrupt increase in intracranial pressure and irritation of the meninges caused by blood in the subarachnoid space. The sudden nature and intensity of the headache distinguish it from other types of headaches and are a hallmark symptom of this condition. Progressive dizziness typically does not present as an immediate symptom of an SAH and is more often associated with other neurological or vestibular issues. Localized seizures can occur after an SAH but are not as commonly recognized as an initial symptom compared to the thunderclap headache. Visual disturbances may also occur, particularly in cases of increased intracranial pressure or if there is involvement of certain cranial nerves, but they are not as specific to SAH in the initial presentation as the thunderclap headache. Therefore, the thunderclap headache is the most characteristic and recognized symptom associated with an aneurysmal subarachnoid hemorrhage.