"Sentinel Seizure" as a Warning Sign Preceding Fatal Rupture of a Giant Middle Cerebral Artery Aneurysm.

Abstract

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. 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. 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.