Abstract
A 40-year-old man had a severe headache of sudden onset and progressive palsy of the third cranial nerve from a minor subarachnoid hemorrhage. Despite assessment by two primary care physicians the possibility of serious neurologic disease was not raised and the urgency of the situation not appreciated. Two weeks after the onset of the headache the patient was urgently admitted to hospital at the request of a neuro-ophthalmologist. Cerebral angiography revealed an aneurysm of the posterior communicating artery, which was surgically occluded with a clip. The patient had a satisfactory recovery, with almost complete return of nerve function by the time of discharge from hospital. Such "warning leaks" in subarachnoid hemorrhage are discussed, and a protocol for their assessment is recommended.
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Selected References
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- Barnett H. J. Some clinical features of intracranial aneurysms. Clin Neurosurg. 1969;16:43–72. doi: 10.1093/neurosurgery/16.cn_suppl_1.43. [DOI] [PubMed] [Google Scholar]
- Drake C. G. Progress in cerebrovascular disease. Management of cerebral aneurysm. Stroke. 1981 May-Jun;12(3):273–283. doi: 10.1161/01.str.12.3.273. [DOI] [PubMed] [Google Scholar]
- Duffy G. P. The "warning leak" in spontaneous subarachnoid haemorrhage. Med J Aust. 1983 May 28;1(11):514–516. doi: 10.5694/j.1326-5377.1983.tb136193.x. [DOI] [PubMed] [Google Scholar]
- Fisher C. M. Clinical syndromes in cerebral thrombosis, hypertensive hemorrhage, and ruptured saccular aneurysm. Clin Neurosurg. 1975;22:117–147. doi: 10.1093/neurosurgery/22.cn_suppl_1.117. [DOI] [PubMed] [Google Scholar]
- Gillingham F. J. The management of ruptured intracranial aneurysms. Scott Med J. 1967 Oct;12(10):377–383. doi: 10.1177/003693306701201007. [DOI] [PubMed] [Google Scholar]
- Kassell N. F., Drake C. G. Timing of aneurysm surgery. Neurosurgery. 1982 Apr;10(4):514–519. doi: 10.1227/00006123-198204000-00019. [DOI] [PubMed] [Google Scholar]
- Okawara S. H. Warning signs prior to rupture of an intracranial aneurysm. J Neurosurg. 1973 May;38(5):575–580. doi: 10.3171/jns.1973.38.5.0575. [DOI] [PubMed] [Google Scholar]
- Waga S., Otsubo K., Handa H. Warning signs in intracranial aneurysms. Surg Neurol. 1975 Jan;3(1):15–20. [PubMed] [Google Scholar]
