title: Intracranial aneurysm rupture presenting as delayed stroke secondary to cerebral vasospasm.
abstract: BACKGROUND
  Days after aneurysmal subarachnoid hemorrhage (SAH), cerebral vasospasm can result in the delayed appearance of ischemic neurological deficit identical to that produced by other causes of stroke. Despite 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 attention.
  
  
  METHODS
  We report our experience with two patients who presented with signs and symptoms of ischemic stroke resulting from cerebral vasospasm that followed unrecognized rupture of a brain aneurysm. In one case, it was the recent complaint of significant headache and a prior history of SAH that led to the correct diagnosis. In the other case, a major rebleed occurred before the accurate diagnosis was recognized.
  
  
  CONCLUSIONS
  It is critical to make the correct diagnosis of stroke due to vasospasm so that appropriate treatment can be instituted, thrombolytic and anticoagulant therapy can be avoided, and the unsecured aneurysm can be obliterated to prevent potentially catastrophic rebleeding.
authors.affiliation: Department of Neurosurgery, University of Minnesota, Minneapolis, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Nussbaum
authors.forename: L A
authors.initials: LA
authors.lastname: Sebring
authors.forename: D Y
authors.initials: DY
authors.lastname: Wen
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis*; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis*; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged