UNRECOGNIZED WARNING LEAK IN RUPTURED INTRACRANIAL ANEURYSM

Early detection of the warning symptoms of subarachnoid haemorrhage (S AH) may be an effective way to achieve a significant reduction of morb idity and mortality. The present study is part of a survey of all case s of SAH observed in 16 neurosurgical and in 8 neurological department s in Italy between June 1985 and June 1986. Out of 619 patients, 364 c ases with aneurysm confirmed by angiography and a detailed clinical hi story were evaluated. Of these, 308 patients were operated. Warning sy mptoms were present in 74 cases (20.3%). Headache (present in 98.6% of cases) associated with vomiting (51.4%), dizzines (20.3%) and transie nt loss of consciousness (12.2%) was the most common event. Symptoms l asted less than 24 h in 71.6% of cases and occurred within 1 month bef ore a major bleeding in 62.2% of cases. In 86.5% of cases, warning lea k 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 t he 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 inc idence of intraventricular and intracerebral haemorrhages was slightly higher in the group with warning leak. Patients with multiple aneurys m had the same frequency of warning signs as patients with single aneu rysms. 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 o utcome of major bleeding. A minor SAH can be correctly and promptly di agnosed on the basis of warning symptoms with a great improvement of t he prognosis.