What are the symptoms of cerebral aneurysms and subarachnoid hemorrhage (SAH)?

Updated: Dec 06, 2018
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Symptoms associated with cerebral aneurysms and SAH are as follows:

  • Headache: This is characterized by the acute onset of severe pain, which patients often describe as "the worst headache of my life." Aneurysmal expansion, thrombosis, or intramural hemorrhage may cause a subacute, unilateral, periorbital headache. Headache does not always accompany aneurysmal SAH.

  • Facial pain: Cavernous-carotid aneurysms may produce facial pain.

  • Alterations in consciousness: The sudden elevation of intracranial pressure associated with aneurysmal rupture may lead to a precipitous decline in cerebral perfusion pressure, causing syncope (50% of cases). Confusion or mild impairment in alertness also may be noted.

  • Seizures: Focal or generalized seizures are present in 25% of aneurysmal SAH cases, with most events occurring within 24 hours of onset.

  • Manifestations of meningeal irritation: Neck pain or stiffness, photophobia, sonophobia, or other hyperesthesia may be noted with SAH.

  • Autonomic disturbances: Subarachnoid accumulation of products of blood degradation may elicit fever. Nausea or vomiting, sweating, chills, and cardiac arrhythmias also may be present.

  • Focal neurological complaints: Hemorrhage or ischemia may manifest with focal deficits including weakness, hemisensory loss, language disturbances, neglect, memory loss, or olfactory disturbances. Focal symptoms are more common with giant aneurysms.

  • Visual symptoms: Blurring of vision, diplopia, or visual field defects may be present.

  • Respiratory dysfunction or cardiovascular instability: These are ominous signs of brainstem compression.

  • Hormonal dysfunction: Intrasellar aneurysms may interfere with pituitary function.

  • Epistaxis: This is noted occasionally with traumatic aneurysms.

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