From the Guidelines
Cerebral aneurysm symptoms often present with sudden and severe headache, frequently described as a "thunderclap headache," accompanied by nausea, vomiting, and altered mental status 1. In some cases, patients may experience localized neurological deficits, such as weakness or numbness, depending on the aneurysm's location and size.
Common Symptoms
- Thunderclap headache: a severe and sudden headache, described by 80% of patients who can give a history 1
- Nausea and vomiting: reported by 77% of patients 1
- Loss of consciousness: occurs in 53% of patients 1
- Nuchal rigidity: present in 35% of patients 1
- Focal neurological deficits: including cranial nerve palsies, depending on the aneurysm's location and size 1 If rupture occurs, immediate medical attention is required, and treatment may involve administration of nimodipine, 60 mg orally every 4 hours for 21 days, to prevent cerebral vasospasm 1. A high index of suspicion is warranted for patients presenting with sudden and severe headache, as diagnosis of a warning leak or sentinel hemorrhage before a catastrophic rupture may be lifesaving 1.
From the Research
Symptoms of a Cerebral Aneurysm
- A sudden and severe headache, often described as a "thunderclap" headache, is the most common presentation of an acutely ruptured cerebral aneurysm 2
- Other symptoms may include neurologic deficits, such as numbness, weakness, and blurred vision 3, 4
- Some patients may experience photophobia, phonophobia, nausea, and vomiting 3
- In some cases, a cerebral aneurysm may present with a sudden, severe headache without any associated neurological deficit 2
Diagnostic Considerations
- A thunderclap headache requires urgent workup to identify the underlying cause, including subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, and other conditions 4, 5, 6
- Diagnostic evaluation may include brain computed tomography, lumbar puncture, and imaging of the brain and cervical vasculature 5, 6
- Early recognition and diagnosis of a cerebral aneurysm are crucial to initiate appropriate therapy and prevent further complications 2, 6