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Washington University Experience | VASCULAR | Aneurysm - Saccular | 18A0 Case 18 History
Case 18 History ---- The deceased is an 82-year-old who presented to the emergency department on 9/13/2018 after suddenly becoming unresponsive following a week of headaches. CT demonstrated a 12 mm right internal carotid artery aneurysm and a large amount of subarachnoid hemorrhage preferentially filling the right parasellar region and right sylvian fissure; with possibly associated right basal ganglion parenchymal hemorrhage. Upon returning from CT she deteriorated and she became unresponsive. An external ventricular drain was placed, was started on Keppra for seizure prophylaxis and nimodipine. The patient underwent cerebral angiogram which demonstrated a large right posterior communicating aneurysm with a wide neck (8.9 mm) which was not amenable to coiling. The hospital course was complicated by generalized tonic clonic seizures, E. coli UTI, hypernatremia, small right pneumothorax, isolated episode of bright red blood per rectum and poor neurological status. CT on 9/16/2018 showed large volume subarachnoid and intraventricular hemorrhage, worsening dilatation of all ventricles and evolving left temporal infarct. On 9/19/2018 the patient had bilateral IVC filters placed for lower extremity DVTs. Supraventricular tachycardia developed as well as episodes of hypotension with mean arterial pressures in the 40s. The patient was on continuous EEG and continued to have seizures. On 09/24/2018, the family decided to transit the patient to comfort care only.
