USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

What is the most serious complication following a subarachnoid hemorrhage, characterized by sudden severe confusion, headache, nausea/vomiting, decreased consciousness, and focal neurological deficits?

1. Vasospasm

2. Hydrocephalus

3. Rebleed

4. Meningitis

The correct answer is: Rebleed

The most serious complication following a subarachnoid hemorrhage is indeed the risk of rebleeding. After an initial hemorrhage, the affected vessel remains fragile and susceptible to further bleeding, which can occur within the first few days or weeks. Rebleeding can lead to a rapid deterioration in the patient's clinical status, characterized by a sudden onset of severe symptoms such as confusion, headache, nausea or vomiting, decreased consciousness, and possibly focal neurological deficits. While vasospasm, hydrocephalus, and meningitis are also potential complications of subarachnoid hemorrhage, they are generally considered less immediately life-threatening in comparison to rebleeding. Vasospasm, for instance, can lead to ischemia and additional neurological deficits, but it typically develops later than the initial bleed. Hydrocephalus can occur due to impaired cerebrospinal fluid absorption and can be serious, but the onset is more gradual. Meningitis is a risk due to the presence of blood in the subarachnoid space but is not as common as rebleeding after an initial hemorrhage. Overall, rebleeding represents an acute and critical threat to the patient's health following a subarachnoid hemorrhage, making it the most serious complication to be