''what familial syndromes are associated with brain aneurysms?'': As far as I remember, some typical syndromes that include brain aneurysmas are APKD( Polycystic kidney), Marfan, Ehlers-Danlos. ''What pathophysiological significance does migraine headaches have in this case?'': I'm not sure but I've read that migraine headaches with aura can sometimes present with sensory or motor symptoms( instead of the visual aura which is more common in this type), so you must probably include it in your differential( focal symptoms of migraine occur in a marching time pattern whereas stroke has an acute onset). Well, I hope this gave u some ideas... ......of course, I do not claim all I say is right..I'm just trying to give some clues for u to search..I haven't studied for CS yet, I am studying for my CK now..but not done with neuro yet.