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Give a Aneurysm patient complaint and history of patient illness

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I have enough to compose a thorough sample case. This is a comprehensive, clinically accurate sample write-up for a ruptured cerebral (intracranial) aneurysm presenting as subarachnoid hemorrhage (SAH) - the format used in nursing/medical case documentation.

Sample Patient Case: Ruptured Cerebral Aneurysm (Subarachnoid Hemorrhage)

Chief Complaint

"Worst headache of my life" - sudden, severe headache with associated neck stiffness and vomiting.

History of Present Illness (HPI)

A 52-year-old woman with a history of hypertension and smoking presented to the emergency department after the sudden onset of a severe, explosive headache approximately 2 hours prior to arrival. The patient reports the pain began abruptly while she was lifting a heavy object at home, reaching maximal intensity ("10/10") within seconds to a minute - a pattern classically described as a "thunderclap headache." She describes it as unlike any headache she has experienced before, localized diffusely but most severe at the occiput, radiating to the neck.
Associated symptoms include:
  • Nausea and vomiting (2 episodes, non-bilious)
  • Neck stiffness/nuchal rigidity and pain on neck flexion
  • Photophobia
  • Brief transient loss of consciousness at onset, lasting less than a minute, witnessed by a family member
  • No reported seizure activity
  • Mild blurred vision, no diplopia
  • No fever at onset
She denies any preceding head trauma. She reports a similar but milder headache episode approximately 2 weeks earlier that resolved spontaneously and was not evaluated - this is suspicious for a "sentinel" or "herald" bleed, which can precede a major aneurysmal rupture by days to weeks.
On arrival, she was noted to be lethargic but arousable, oriented to person only, with photophobia and nuchal rigidity on exam. Vital signs showed hypertension (BP 178/98 mmHg) and mild tachycardia. No focal motor deficit was noted, though pupillary exam showed early anisocoria concerning for possible third cranial nerve palsy (raising concern for a posterior communicating artery aneurysm).

Past Medical History

  • Hypertension (poorly controlled, on lisinopril, inconsistent adherence)
  • No known diabetes
  • No prior stroke or aneurysm history
  • No known connective tissue disorder (e.g., polycystic kidney disease, Marfan syndrome, Ehlers-Danlos)

Past Surgical History

  • None significant

Family History

  • Mother had a "brain hemorrhage" in her 60s (family history of intracranial aneurysm/SAH is a recognized risk factor)

Social History

  • Smoker: 1 pack/day for 20 years (major modifiable risk factor for aneurysm formation and rupture)
  • Occasional alcohol use; denies illicit drug use (cocaine use is a recognized precipitant of rupture)
  • Works as an office administrator

Medications

  • Lisinopril 10 mg daily (adherence poor)

Allergies

  • No known drug allergies

Review of Systems

Positive for headache, neck pain, photophobia, nausea/vomiting, and transient loss of consciousness as above. Negative for fever, chest pain, focal weakness, numbness, or bowel/bladder incontinence at time of presentation.

Clinical Reasoning / Key Red Flags in This History

  1. Thunderclap headache - abrupt onset reaching peak intensity within seconds/minutes is the hallmark presenting symptom of aneurysmal SAH.
  2. Sentinel headache 1-2 weeks prior - a warning leak that is frequently missed or misattributed to migraine/tension headache.
  3. Exertional onset (heavy lifting) - exertion, Valsalva, and sudden BP surges are common triggers for rupture.
  4. Meningismus (neck stiffness, photophobia) - from blood irritating the subarachnoid space and meninges.
  5. Transient LOC at onset - reflects the acute rise in intracranial pressure at the moment of rupture.
  6. Modifiable risk factors - smoking and uncontrolled hypertension are the two strongest modifiable risk factors for aneurysm formation and rupture.
  7. Family history - first-degree relative with SAH/aneurysm significantly raises risk and would prompt screening in surviving relatives.
  8. Anisocoria/possible CN III palsy - classically associated with a posterior communicating artery aneurysm compressing the oculomotor nerve.
As sources note, "the classic presentation of a subarachnoid hemorrhage is the sudden onset of the worst headache of the patient's life" - Plum and Posner's Diagnosis and Treatment of Stupor and Coma. Similarly, thunderclap headache associated with an intracerebral aneurysmal leak (sentinel/herald hemorrhage) "may precede catastrophic aneurysmal rupture by days to weeks" - Tintinalli's Emergency Medicine.

Typical Next Steps (for context)

Non-contrast CT head (highly sensitive within 6 hours of onset), CT angiography to localize the aneurysm, lumbar puncture if CT is negative but suspicion remains high (looking for xanthochromia), and neurosurgical/neurointerventional consultation for aneurysm securing (coiling or clipping) plus nimodipine for vasospasm prophylaxis.
Would you like me to also draft the nursing history/assessment format (e.g., SOAP note, admission history and physical, or a nursing care plan with diagnoses and interventions) based on this case?
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