TY - CHAP M1 - Book, Section TI - Subarachnoid Hemorrhage A1 - Lee, Kiwon A2 - Lee, Kiwon PY - 2012 T2 - The NeuroICU Book AB - A 49-year-old man with history of hypertension and hyperlipidemia presents with a sudden onset of severe bifrontal headache followed by nausea. The patient vomited on his way to the nearby emergency department (ED) and became obtunded in the ambulance. On arrival to the ED, he was intubated for airway protection as his mental status continued to worsen. About 30 minutes after the onset of the initial symptoms, he progressed to stuporous mental status with minimal but intact withdrawal responses to painful stimulation. Brainstem reflexes were intact. Stat head computed tomography (CT) (Figure 1-1) revealed acute subarachnoid hemorrhage (SAH) filling the basal cistern, bilateral sylvian fissures with thick hemorrhages along with early radiographic evidence for hydrocephalus, and intraventricular hemorrhage (IVH) mainly in the fourth ventricle. The local ED physicians decided to transfer the patient immediately to the nearest tertiary medical center. During the emergent transfer, patient stopped responding to any painful stimuli and had only intact brainstem reflexes.On arrival at the neurologic intensive care unit, the following is the clinical observation: Patient is intubated with endotracheal tube, in coma, decerebrate posturing on painful stimulation, intact corneal reflexes, pupils 5 mm in diameter briskly constricting to 3 mm bilaterally to the light stimulation, intact oculocephalic reflexes, and positive bilateral Babinski signs.Vital signs: HR 110 bpm in sinus tachycardia, RR 20 breaths/min on the set rate of 14 breaths/min on assist control–volume control mechanical ventilation, temperature: 99.3°F, BP: 190/100 mm Hg by cuff pressure on arrival to the NeuroICU. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - neurology.mhmedical.com/content.aspx?aid=1101642253 ER -