Current RMA Instruments
| Reasonable Hypothesis SOP | 67 of 2019 |
| Balance of Probabilities SOP | 68 of 2019 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 430,852.00-852.3
- ICD-10-AM Codes: I60, S06.6
Brief description
Subarachnoid haemorrhage is bleeding in the space between the innermost and middle layers of the meninges that cover the brain and spinal cord. Not all forms of subarachnoid haemorrhage are covered by this SOP. Bleeding that extends into the subarachnoid space from a cerebral haemorrhage or a bleeding cerebral tumour is excluded. Bleeding in the subarachnoid space around the spinal cord is also not covered. Bleeding due to trauma or certain bleeding disorders, previously excluded from this SOP, is now covered. Most SAHs are caused by ruptured saccular aneurysms. Subarachnoid haemorrhage is typically a medical emergency and it has a high mortality rate.
Confirming the diagnosis
The diagnosis may be suspected on clinical grounds, but confirmation requires imaging, usually in the form of a CT scan of the head. Angiography may also be performed to identify the cause of the bleed. A lumbar puncture may also be performed.
The relevant medical specialist is a neurologist or neurosurgeon.
Additional diagnoses that may be covered by SOP
- Ruptured cerebral berry or saccular aneurysm
- Ruptured arteriovenous malformation
Conditions not covered by SOP
- Epidural haemorrhage#
- Intracerebral haemorrhage* - cerberovascular accident SOP
- Subarachnoid haemorrhage around the spinal cord#
- Subarachnoid haemorrhage due to cerebral tumour - code to underlying neoplasm
- Subarachnoid haemorrhage that is an extension from an intracerebral haemorrhage* - cerberovascular accident SOP
- Subdural haemorrhage*
* another SOP applies
# non-SOP condition
Clinical onset
The time of clinical onset will generally be obvious from the initial clinical presentation. The condition usually presents acutely, with sudden onset of very severe headache. There may also be altered consciousness, collapse or vomiting at onset.
Clinical worsening
The only SOP worsening factor is for inability to obtain appropriate clinical management. Urgent hospital treatment is required. The mortality rate for the condition is around 50%. Neurological deficits are common in survivors even with appropriate treatment.