The importance of sentinel headache in patients with intracranial aneurism

Abstract

In patients with intracranial aneurism, the headache is often similar to the headache in subarachnoidal hemorrhage (SAH) and is called as sentinel headache. Sentinel headache is sudden at onset and severe, which occurs days before the rupture of aneurism. A 27 years old female, with 30- weeks pregnant, presented with a sudden onset severe headache and vomiting. In the past medical history of the patient, there were no abnormal features. She had admitted to a policlinic for a sudden onset and severe headache fifteen days ago. It had been thought that she had a migraine headache. On admission, the Glasgow Coma Scale score was 14 and the cranial computed tomography was consistent with SAH findings. When the patient presented with immediate and severe headache, it shouldn’t be forgotten that patient’s headache could be a sentinel headache. Although small number of aneurism cases results in SAH, because of the high morbidity and mortality of SAH, cranial tomography and if it is normal lomber punction, magnetic resonance angiography and catheter angiography should be carried out respectively in patients with sentinel headache.