INTRACRANIAL ANEURYSM RUPTURE PRESENTING AS DELAYED STROKE SECONDARY TO CEREBRAL VASOSPASM

Background Days after aneurysmal subarachnoid hemorrhage (SAH), cerebr al vasospasm can result in the delayed appearance of ischemic neurolog ical deficit identical to that produced by other causes of stroke. Des pite the well-described, ''classic'' presentation of SAH, up to 25% of patients are initially misdiagnosed, and the initial hemorrhage from a ruptured aneurysm will not always bring the patient to medical atten tion. Case Descriptions We report our experience with two patients who presented with signs and symptoms of ischemic stroke resulting from c erebral vasospasm that followed unrecognized rupture of a brain aneury sm. In one case, it was the recent complaint of significant headache a nd a prior history of SAH that led to the correct diagnosis. In the ot her case, a major rebleed occurred before the accurate diagnosis was r ecognized. Conclusions It is critical to make the correct diagnosis of stroke due to vasospasm so that appropriate treatment can be institut ed, thrombolytic and anticoagulant therapy can be avoided, and the uns ecured aneurysm can be obliterated to prevent potentially catastrophic rebleeding.