title: "Sentinel Seizure" as a Warning Sign Preceding Fatal Rupture of a Giant Middle Cerebral Artery Aneurysm.
abstract: BACKGROUND
  Sentinel headache is a well-known warning sign preceding subarachnoid hemorrhage (SAH) caused by rupture of an intracranial aneurysm. New-onset seizure or "sentinel seizure" preceding aneurysmal SAH, however, is uncommon.
  
  
  METHODS
  We report a 51-year-old man with a new-onset seizure. Diagnostic workup revealed a giant middle cerebral artery aneurysm without evidence of subarachnoid or intracerebral hemorrhage. Antiepileptic therapy was initiated, elective diagnostic angiography and subsequent treatment was scheduled, and the patient was discharged home. Four days later, he suddenly lost consciousness and subsequently died of a massive aneurysmal SAH.
  
  
  CONCLUSIONS
  As with sentinel headache, new-onset seizures in patients with unruptured intracranial aneurysms might prompt immediate treatment to prevent imminent SAH with its subsequent high morbidity and mortality.
authors.affiliation: Department of Neurosurgery, University of Bern, Inselspital, Bern, Switzerland; Department of Neurosurgery and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lukas
authors.initials: L
authors.lastname: Andereggen
authors.affiliation: Department of Neurosurgery, University of Bern, Inselspital, Bern, Switzerland. Electronic address: robert.andres@hin.ch.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Andres
mesh_terms: D017542:Aneurysm, Ruptured / Q000175:diagnosis*; D002539:Cerebral Arterial Diseases / Q000175:diagnosis* / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy
keywords: Aneurysm; Seizure; Sentinel headache; Subarachnoid hemorrhage