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Washington University Experience | VASCULAR | Aneurysm - Saccular | 14A0 Case 14 History
Case 14 History ---- The patient was a 31 year old woman with a history of alcohol, tobacco, and
intranasal cocaine abuse who originally presented to BH on 1/11 with 2 weeks of intermittent throbbing bitemporal headaches. She described them as worse in the evening and only slightly relieved with aspirin. At that time she had a normal neurologic exam and was discharged to home, and advised to discontinue her drug abuse and seek neurologic follow-up. Sometime in late January she reportedly fell in her bathroom and had severe headaches, but these eventually resolved with aspirin and the application of a cold towel. She again presented to BH on 2/2 after being found unresponsive by family members. She was noted to experience multiple generalized tonic-clonic seizures, and on exam she was found to have fixed 6 mm pupils and no sign of brainstem nor cortical function. Head CT without contrast revealed a massive intracranial hemorrhage with subarachnoid, intraventricular and frontal intraparenchymal blood. A drug screen was unremarkable. Serial neurologic examinations revealed no improvement, and a radionuclide and brain scan demonstrated no effective intracerebral blood flow and she was placed on comfort measures only.
