Sentinel symptoms and signs of intracranial aneurysms

Despite advances in the management and surgery of aneurysmal subarachnoid hemorrhage, fewer than half of the patients surviving to hospital admissions have favorable outcomes. This is due to the primary and secondary effects of the hemorrhage. Studies have shown that as many as 40% of ruptured aneurysms had preceding warning symptoms and signs. These warnings include severe headache and cranial nerve palsies, especially the third cranial nerve. Seizures, focal deficits or transient ischemic attacks are rarely warnings. Evaluation should include, in this order, computed tomography scan, lumbar puncture and angiography as indicated. Surgery on symptomatic non-ruptured aneurysms is associated with a greater than 95% chance of a very good outcome and less than 1% mortality rate.