Why Do Patients With Aneurysmal Subarachnoid Hemorrhage Postpone Treatment?

Early diagnosis of cerebral arterial aneurysm (CAA) rupture is critical, as recurrent ruptures significantly worsen the prognosis and increase mortality. The time to seek help varies: thunderclap headache and seizures prompt immediate treatment, while less obvious manifestations are often overlooked. The relationship between the nature of symptoms and the promptness of CAA rupture diagnosis remains poorly understood. To identify predictors of help-seeking behavior in patients with recurrent CAA ruptures.

A retrospective single-center analysis from the medical records of 448 patients with ruptured CAA (2000-2023) was performed. Patients were divided into 2 groups based on the number of CAA ruptures. In both groups the pre-hospital period was defined as the time from the first rupture to the diagnosis of CAA. Factors affecting the timeliness of diagnosis were evaluated: sociodemographics, CAA characteristics, neurological symptoms at the time of CAA rupture, physician's specialty.

Our study revealed significant diagnostic delays in patients with recurrent CAA ruptures due to delayed help-seeking, with verification occurring 5-6 days later than in those with single ruptures. Recurrent thunderclap headaches paradoxically prolonged diagnosis, while severe manifestations (paresis, seizures, transient loss of consciousness) accelerated verification by 12-23 days. Evaluation by a neurologist/neurosurgeon reduced delays by nearly 7 days, whereas misdiagnosis by non-specialized physicians caused almost 10-day delays.

The main predictors of delayed consultation include non-focal symptoms, female gender, and social-psychological barriers. Improving early diagnosis and raising patient awareness of CAA risks are crucial.