In this issue of JAMA Neurology, Suwatcharangkoon et al1 retrospectively analyze a prospective series of 1460 patients with spontaneous subarachnoid hemorrhage (SAH). Forty percent of the patients had loss of consciousness (LOC) at the onset of SAH. The key finding was that LOC was associated with worse clinical grade, larger hemorrhages, global cerebral edema, and poor outcome, although not with delayed cerebral ischemia.