? Is there ever a warning sign before the overt rupture of an intracranial aneurysm?
The hallmark presenting symptom of aneurysmal subarachnoid hemorrhage is “the worst headache of my life.” The onset of the headache is sudden, and the headache is severe and reaches maximal intensity in seconds (known as a thunderclap headache). In 10 to 40% of patients, this headache is preceded by a warning leak or “sentinel” headache, which typically occurs within 2 to 8 weeks before overt subarachnoid hemorrhage.
? What is the risk of rerupture after the initial rupture of an intracranial aneurysm?
Aneurysm rerupture is associated with a very high risk of death and worse neurologic recovery among survivors. The risk of rerupture is 4 to 14% in the first 24 hours after aneurysmal subarachnoid hemorrhage, but the risk remains elevated for 30 days after the initial rupture if the aneurysm is not treated.
Figure CT Scan of the Head Showing Evidence of Subarachnoid Hemorrhage.