Subarachnoid hemorrhage typically starts abruptly with an intense ("thunderclap") headache but sometimes the symptoms are atypical. The mortality is approximately 50%. Correct immediate diagnosis is important because the hemorrhage is usually caused by a treatable aneurysm. Computer tomography (CT) is the principal diagnostic method on arrival to the emergency room. If the CT is negative and the situation remains unclear, examination of the cerebrospinal fluid is essential and should entail analysis of heme pigments, especially in warning leaks and after delayed admission. Only spectrophotometry of the sample is sensitive enough and should replace visual inspection.
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