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Washington University Experience | VASCULAR | Aneurysm - Saccular | 4A0 Case 4 History
Case 4 History ---- The patient is an 80 year old man who has a past history for sleep apnea, hypertension, and pulmonary embolism for which he was on Coumadin therapy. He developed a headache, right leg numbness, and neck stiffness on the morning of 1/3/98 after which he collapsed and became unresponsive. The patient was taken to an outside hospital where he was intubated and head CT scan obtained which demonstrated subarachnoid hemorrhage in the basilar cisterns and bilateral sylvian fissures. The patient was transferred to Barnes-Jewish Hospital for possible treatment by the neurosurgery service. Upon arrival, the patient was comatose; his pupils were 2.5 mm bilaterally and fixed; and no doll's eyes, gag or corneal reflexes were present. Given the patient's grade V subarachnoid hemorrhage and his strong living will indicated that no extraordinary measures were to be performed to prolong his life. It was felt by the family that the patient should have supportive care only. However, on 1/4/98 the patient's neurologic exam improved; i.e., he opened his eyes to voice, followed commands with all four extremities, and exhibited reactive pupils. At that point, given his hydrocephalus and previously noted CT scan findings, it was recommended to the family that the neurosurgeons proceed with the ventriculostomy to relieve the hydrocephalus. The shunt was placed to the right frontal lateral ventricle and immediate return of blood tinged CSF from the shunt line was noted. The patient continued to improve and due to the patient's improving mental status, an embolization procedure using delicate wires was performed on the aneurysm which showed 90% obliteration radiographically following the procedure. Shortly thereafter, the patient's intracranial pressure increased and blood appeared in the ventricular drain. The patient's pupils became unresponsive with no reflexes, thought to be caused by recurrent bleeding from the aneurysm. The patient was pronounced dead in January/1998.
