Is the "Warning Leak" in SAH a Myth?

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating neurologic catastrophe. A severe, unanticipated headache occurring days to weeks before this cataclysmic event has traditionally been labeled a "warning leak." Indeed, up to half of patients asked about prior acute headaches answer affirmatively. Thus, in many acutely ill patients, SAH could represent a rerupture. For this reason, many neurosurgeons believe that significant progress in the management of SAH can be made only with increased recognition of these warning leaks and with speedy treatment of such fragile aneurysms on the brink of massive rupture.

These authors challenge the existence of warning leaks. A retrospective analysis of their SAH database revealed that 44 of 390 pat…