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June 23, 1951


Author Affiliations

New York

From the Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, and the Neurological Institute of New York. Members of the medical and surgical staffs of the Columbia-Presbyterian Medical Center permitted me to include their cases in this report.

JAMA. 1951;146(8):693-698. doi:10.1001/jama.1951.03670080001001

Spontaneous subarachnoid hemorrhage is the non-traumatic extravasation of blood into the subarachnoid space. It is an episode in the course of an intracranial process and is not a disease entity. It is characterized, as a rule, by the sudden onset of severe headache, usually generalized, but most intense in the suboccipital or frontal region; vomiting; collapse, and coma in many instances. Stiffness of the neck then develops, and the patient may have other symptoms and signs due to pressure on adjacent structures. The commonest of these are pain on one side in the temporal or frontal region, double vision and drooping of one eyelid. These findings, of course, are the result of pressure on the fifth and third cranial nerves. There may be mental changes or abnormalities in strength, coordination, reflexes, sensation or functions of other cranial nerves. On the other hand, there may be no focal neurological signs or