Delayed Diagnosis of Intracranial Aneurysms: Confounding Factors
Delayed Diagnosis of Intracranial Aneurysms: Confounding Factors
The initial presentation of intracranial aneurysm can be missed in routine clinical practice. An underlying aneurysm may have a subtle presentation that warrants definitive diagnostic procedures. A retrospective review of 270 patients with aneurysms at our institution revealed 40 patients (14.8%) with a significant delay in diagnosis before definitive treatment. The delay due to missed diagnosis varied from 2 days to a few months. In retrospect, 58% had a Hunt and Hess grade I clinical presentation at readmission. Clinical status was rated as grade 0-I in the majority of patients (65%), grade II in 20%, and grade III in 12.5%. One patient had grade IV status. These grades are significantly different from the initial grade at which each of the patients first sought medical attention. The second admission significantly affected the outcome. A delay in diagnosis of aneurysmal subarachnoid hemorrhage resulting in poor clinical grade influenced neurologic outcome significantly.
Aneurysmal subarachnoid hemorrhage affects 28,000 people per year and is associated with death or permanent disability in nearly two thirds of patients. Many patients with intracranial aneurysms have symptoms preceding the major rupture, but the significance of these symptoms is often not recognized by medical personnel. Recent neurosurgical improvements have reduced the mortality and morbidity of ruptured aneurysms. The association between clinical status and outcome warrants vigilance on the part of the physician in the early diagnosis of aneurysms when only premonitory symptoms are present. A warning leak, if interpreted correctly to diagnose aneurysmal subarachnoid hemorrhage, has significant potential to improve overall outcome.
The initial presentation of intracranial aneurysm can be missed in routine clinical practice. An underlying aneurysm may have a subtle presentation that warrants definitive diagnostic procedures. A retrospective review of 270 patients with aneurysms at our institution revealed 40 patients (14.8%) with a significant delay in diagnosis before definitive treatment. The delay due to missed diagnosis varied from 2 days to a few months. In retrospect, 58% had a Hunt and Hess grade I clinical presentation at readmission. Clinical status was rated as grade 0-I in the majority of patients (65%), grade II in 20%, and grade III in 12.5%. One patient had grade IV status. These grades are significantly different from the initial grade at which each of the patients first sought medical attention. The second admission significantly affected the outcome. A delay in diagnosis of aneurysmal subarachnoid hemorrhage resulting in poor clinical grade influenced neurologic outcome significantly.
Aneurysmal subarachnoid hemorrhage affects 28,000 people per year and is associated with death or permanent disability in nearly two thirds of patients. Many patients with intracranial aneurysms have symptoms preceding the major rupture, but the significance of these symptoms is often not recognized by medical personnel. Recent neurosurgical improvements have reduced the mortality and morbidity of ruptured aneurysms. The association between clinical status and outcome warrants vigilance on the part of the physician in the early diagnosis of aneurysms when only premonitory symptoms are present. A warning leak, if interpreted correctly to diagnose aneurysmal subarachnoid hemorrhage, has significant potential to improve overall outcome.
