RT Book, Section
A1 Lee, Kiwon
A2 Lee, Kiwon
SR Print(0)
ID 1101642253
T1 Subarachnoid Hemorrhage
T2 The NeuroICU Book
YR 2012
FD 2012
PB McGraw-Hill Education
PP New York, NY
SN 9780071636353
LK neurology.mhmedical.com/content.aspx?aid=1101642253
RD 2023/05/27
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.