Ultra-Early Aneurysmal Rebleeding and Brainstem Destruction

Abstract

Background  

Early secondary neurologic deterioration after aneurysmal subarachnoid hemorrhage (SAH) may have many causes including rebleeding, hydrocephalus, parenchymal hematoma, or seizures.

Methods  

Case report.

Results  

A 69-year-old woman presented with thunderclap headache and nausea. A head computed tomography (CT) showed SAH. On initial evaluation she was awake, alert, and confused without focal neurologic deficits. Two episodes of marked clinical deterioration occurred, manifesting as acute unresponsiveness and fixed anisocoria. Serial head CTs showed massive extension of hemorrhage into the brainstem parenchyma and ventricles.

Conclusions  

Sudden clinical deterioration after SAH with coma and a fixed "blown" pupil may result from hemorrhage extension into the brainstem parenchyma rather than oculomotor nerve injury from compression or stretch.

• Content Type Journal Article
• Category Neuroimage
• Pages 1-2
• DOI 10.1007/s12028-011-9648-y
• Authors
  • Jennifer E. Fugate, Division of Critical Care Neurology, Mayo Clinic, Rochester, MN 55905, USA
  • Grant W. Mallory, Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA
  • Eelco F. M. Wijdicks, Division of Critical Care Neurology, Mayo Clinic, Rochester, MN 55905, USA

• Journal Neurocritical Care
• Online ISSN 1556-0961
• Print ISSN 1541-6933

http://www.springerlink.com/content/95371015675hm5w3/

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