Warning signs in subarachnoid hemorrhage: a cooperative study

Bassi, Pietro; Bandera, R.; Loiero, Mario; Tognoni, Gianni; Mangoni, A

doi:10.1111/j.1600-0404.1991.tb04954.x

Cited by 91 publications

(41 citation statements)

References 12 publications

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“…187,197,198 The importance of recognizing a warning leak cannot be overemphasized. Headache is a common presenting chief complaint in the ED, and SAH accounts for only 1% of all headaches evaluated in the ED.…”

Section: Clinical Manifestations and Diagnosis Of Aneurysmal Sahmentioning

confidence: 99%

“…The sine qua non of SAH in an awake patient is the complaint of "the worst headache of my life," described by Ϸ80% of patients who can give a history, but a warning or sentinel headache is also described by Ϸ20% of patients. 187,188 Most intracranial aneurysms remain asymptomatic until they rupture. Although aneurysmal SAH occurs frequently during physical exertion or stress, SAH can occur at any time.…”

Section: Clinical Manifestations and Diagnosis Of Aneurysmal Sahmentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Bederson¹,

Connolly²,

Batjer³

et al. 2009

Stroke

1,156

488

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Section: Clinical Manifestations and Diagnosis Of Aneurysmal Sahmentioning

confidence: 99%

Section: Clinical Manifestations and Diagnosis Of Aneurysmal Sahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Bederson¹,

Connolly²,

Batjer³

et al. 2009

Stroke

1,156

488

View full text Add to dashboard Cite

“…Among 1752 patients with aneurysm rupture from 3 series, 340 (19.4%; range, 15%-37%) had a history of a sudden severe headache before the event that led to admission. 82,95,97 The importance of recognizing a warning leak cannot be overemphasized. Headache is a common presenting chief complaint in the emergency department, and aSAH accounts for only 1% of all headaches evaluated in the emergency department.…”

Section: Clinical Manifestations and Diagnosis Of Asahmentioning

confidence: 99%

“…The hallmark of aSAH in a patient who is awake is the complaint "the worst headache of my life," which is described by Ϸ80% of patients who can give a history. 82 This headache is characterized as being extremely sudden and immediately reaching maximal intensity (thunderclap headache). A warning or sentinel headache that precedes the aSAH-associated ictus is also reported by 10% to 43% of patients.…”

Section: Clinical Manifestations and Diagnosis Of Asahmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,917

1,375

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Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

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“…The inci dence of warning signs in different studies varies from 15 strategy for reducing mortality and morbidity after sub arachnoid haemorrhage (SAH) [6,7], Hitchcock [8] sug gested the reduction could be from 40% to below 10%. While the importance of recognizing the minor leak is obvious, little has been done to determine its clinical manifestations and their role in the course and outcome of the disease.…”

Section: Introductionmentioning

confidence: 99%

Unrecognized Warning Leak in Ruptured Intracranial Aneurysm

Versari¹,

Bassi²,

Limoni³

et al. 1993

Cerebrovasc Dis

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Early detection of the warning symptoms of subarachnoid haemorrhage (SAH) may be an effective way to achieve a significant reduction of morbidity and mortality. The present study is part of a survey of all cases of SAH observed in 16 neurosurgical and in 8 neurological departments in Italy between June 1985 and June 1986. Out of 619 patients, 364 cases with aneurysm confirmed by angiography and a detailed clinical history were evaluated. Of these, 308 patients were operated. Warning symptoms were present in 74 cases (20.3%). Headache (present in 98.6% of cases) associated with vomiting (51.4%), dizzines (20.3%) and transient loss of consciousness (12.2%) was the most common event. Symptoms lasted less than 24 h in 71.6% of cases and occurred within 1 month before a major bleeding in 62.2% of cases. In 86.5% of cases, warning leak was severe enough for patients to seek medical care. In only 7 cases a suspected diagnosis of SAH was made. In the group with minor leak the grading (Hunt-Hess score) on admission was worse than in the group without it (51.4 vs. 34.1 % with grade III or more, p < 0.01). The incidence of intraventricular and intracerebral haemorrhages was slightly higher in the group with warning leak. Patients with multiple aneurysm had the same frequency of warning signs as patients with single aneurysms, the size and the location of aneurysms have no influence on the warning leak. The group without minor leak had a higher incidence of favourable outcomes at discharge (good recovery, 46.9 vs. 33.8%, p < 0.05). A minor leak is an important event and can indicate a negative outcome of major bleeding. A minor SAH can be correctly and promptly diagnosed on the basis of warning symptoms with a great improvement of the prognosis.

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Warning signs in subarachnoid hemorrhage: a cooperative study

Cited by 91 publications

References 12 publications

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Unrecognized Warning Leak in Ruptured Intracranial Aneurysm

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