• Lukas Andereggen and Robert H Andres.
• 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.
• World Neurosurg. 2017 Apr 1; 100: 709.e11-709.e13.

BackgroundSentinel 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.Case DescriptionWe 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.ConclusionsAs 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.Copyright © 2017. Published by Elsevier Inc.

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