Walsh & Hoyt: Manifestations of Ruptured Saccular Aneurysms

Few events in human disease can be so sudden and potentially catastrophic as the spontaneous rupture ofa major intracranial artery. Depending on the size and nature of the mural defect, the escaping blood may dissect within the vessel wall, ooze slowly around the site, or gush forth under high pressure into the subarachnoid space and the adjacent brain. Pressure within the enclosed cranial vault may rise precipitously until it equals the pressure within the leaking vessel. At the same time, the damaged artery contracts, unless sclerotic changes in its wall prevent it from doing so, and the bleeding stops. Clinically, the patient, often without warning, suddenly experiences an excruciating pain in the head. Directly thereafter, the patient collapses and may experience a generalized or focal seizure. Depending on the location and extent of the hemorrhage, the patient may die immediately or within a few hours, remain in coma for days, or regain consciousness after minutes or hours. The patient may ultimately recover completely, have a persistent major or minor neurologic deficit, or die of a recurrent hemorrhage.