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September 10, 1982

Neurosurgeons debate best treatment of aneurysms

JAMA. 1982;248(10):1158-1159. doi:10.1001/jama.1982.03330100010004

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Neurosurgeons are taking a long look at why— despite improved therapy—aneurysmal subarachnoid hemorrhage continues to take a high toll among persons who often are in their most productive years.

Some estimates are that an intracranial aneurysm lurks in one of every 50 North Americans. A first-time leak may occur in some 28,000 persons in the United States and Canada during the next year, with often devastating results.

So far, says Neal F. Kassell, MD, professor of neurosurgery at the University of Iowa College of Medicine, Iowa City, at least two significant points have become clear.

One is that more prompt recognition is needed by patients and physicians alike of the symptoms of aneurysmal subarachnoid hemorrhage. These include a headache that has been described as "explosively" sudden in onset and more painful than any headache previously experienced by the patient. In such instances, prompt accurate diagnosis is mandatory, with early referral