**4.1 Presentation**

*New Insight into Cerebrovascular Diseases - An Updated Comprehensive Review*

VerifyNow can overestimate the rate of clopidogrel resistance when compared to TEG. However, there is currently no randomized trials that have assessed the utility of this tests. Moreover, there's no strong evidence to support that the assessment of platelet reactivity improves clinical and imaging outcomes after stent placement. Nevertheless, the neuro-interventional teams at these days usually starts the DAPT with 325 mg of ASA and 75 mg of clopidogrel 7 days prior and maintain for

A 50-year-old female was preparing her children for school when she experienced a headache severe enough to make her lie down on the sofa. She managed to get the children off to school, but the headache did not abate. She was used to headaches, as she had migraines periodically that were controlled with over-thecounter medications, but this one was different and much more intense. She took a couple of acetaminophen, and when the pain was not relieved, she brought herself

Headache is seen in up to 2% of patients, presenting to the emergency department (ED). Most are benign, but it is imperative to understand and discern the life-threatening causes of headache when they present. Headache caused by a subarachnoid hematoma (SAH) from a ruptured aneurysm is one of the deadliest, but fortunately,

also rare, comprising only 1% of all headaches presenting to the ED [74]. Rupture is the most serious consequence of intracranial aneurysms. Subarachnoid hemorrhage (SAH) from a leaking aneurysm is a neurological emergency. While SAH is typical of aneurysmal rupture, it is also associated with intraventricular hemorrhage, intracerebral hemorrhage, and subdural hematoma. The force of rupture and location of an aneurysm determine the presence of the other types of hemorrhage. Although the prevalence of aneurysms is high, the

**190**

3–6 months after PED placement.

**Figure 4.**

**4. Ruptured intracranial aneurysms**

*Flowchart of management after incidental UIA diagnosis.*

to the emergency department (ED) [73].

The presenting symptom of SAH is acute headache, generally described as "the worst headache of my life."

Some cohort studies mention it as "thunderclap" headache that peaks at headache onset or reaches severity within minutes to an hour of onset [75].

	- Terson syndrome: hemorrhage in vitreous humor, associated with high mortality [78]
	- Subhyaloid (pre-retinal) hemorrhage [79].
