subarachnoid hemorrhage vs. meningitis

[MudPhud20XX]

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Alright, so these two are similar in a sense that both are:

1. sudden onset
2. give meningeal irritation (headache, stiff neck, photophobia)
3. even fever

Kaplan says to differentiate the two, you need to have loss of consciousness for subarachnoid hemorrhage due to increased intracranial pressure. However, doesn't you also get increased intracranial pressure, thus may lose consciousness in meningitis?

Also, why would hemorrhage give you fever?

I would really appreciate some insight especially those who encountered similar cases in the clinic. Many thanks in advance.

 

[igcgnerd]

What they have in common:
-may present as headache/ neck pain
-increased ICP
-nuccal rigidity
-altered level of consciousness.

Unique to SAH:
-"worst headache in life"
-sudden onset (min's to a few hours)
-afebrile
-possible LOC

Unique to meningitis:
-fever and other infectious symptoms
-usually a gradual onset (hours to days)
-LOC very rare
-may have rash associated with it (This one is quite obvious. If the bug happens to be Nesseria, over 40% of the time a rash will be present)

Both these type of patients need head CT's. The definitive test is always a LP.