True about giant aneurysm

the consequences of a cerebral aneurysm, aneurysmal subarachnoid hemorrhage (SAH) has devastating consequences. Signs and symptoms Symptoms associated with cerebral aneurysms and SAH are as follows: Headache Facial pain Alterations in consciousness Seizures Manifestations of meningeal irritation Autonomic disturbances Focal neurologic complaints Visual symptoms Respiratory dysfunction Cardiovascular instability Hormonal dysfunction Epistaxis Specific physical examination findings may include prominent scalp veins, signs of congestive hea failure (eg, vein of Galen aneurysms), or orbital bruits (eg, cavernous carotid aneurysms). Neurologic findings exhibit considerable variability because of differences in aneurysm characteristics. These findings include the following: Aneurysmal SAH: May be accompanied by nuchal rigidity, decreased level of consciousness, subhyaloid hemorrhages, pupillary abnormalities (ie, typically dilated), ophthalmoplegia, cranial neuropathies, and other focal deficits Giant aneurysms or dolichoectatic aneurysms: May cause mass effects and distal thromboembolism with prominent focal deficits; these aneurysms may also result in optic atrophy or other cranial neuropathies or cause brainstem compression. Ref: Medscape