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Retrospective surveys of patients with subarachnoid hemorrhage suggest that minor episodes with sudden headache(warning leaks)may precede rupture of an aneurysm,and that early recognition and surgery might lead to improved outcome.We studies 148 patients with sudden and severe headache (possible sentinel headache)seen by 252 general practitioners in a 5-year period in the Netherlands.Subarachnoid hemorrhage was the cause in 37 patients(25%)(proven aneurysm in 21,negative angiogram in 6,no angiogram done in 6,sudden headache followed by death in 4).103 patients had headache as the only symptom,12 of whom proved to have subarachnoid hemorrhage(6 with a ruptured aneurysm).Previous bouts of sudden headache had occurred in only 2.Other serious neurological conditions were diagnosed in 18.In the remaining 93,no underlying cause of headache was found;follow-up over 1 year showed no subsequent subarachnoid hemorrhage or sudden death.In this cohort,acute,severe headache in general practice indicated a serious neurological disorder in 37%(95%C1 29-45%),and subarachnoid hemorrhage in 25%(18-32%).12%(5-18%)of those with headache as the only symptom.The notion of warning leaks as a less serious variant of subarachnoid hemorrhage is not supported by this study.Early recognition of subarachnoid hemorrhage is important but will probably have only limited impact on the outcome in the general population. |
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aneurysm
aneurysm,intracranial
aneurysm,intracranial,warning leak headache with
headache
headache,severe
headache,sudden onset of
subarachnoid hemorrhage
sudden death
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