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Washington University Experience | VASCULAR | Aneurysm - Saccular | 7A0 Case 7 History
Case 7 History ---- The patient was a 52 year old man with a history of smoking and aneurysmal subarachnoid hemorrhage who presented for elective clipping of an asymptomatic aneurysm. Family history is notable for a fatal aneurysmal rupture in his mother. He initially presented to an outside hospital in July 2009 after collapsing at home. Head CT at the time revealed diffuse subarachnoid hemorrhage overlying the cerebral convexities, and extending throughout the ventricular system into the basilar cisterns (Hunt-Hess Grade II; Fisher Grade 3+4). There was a small focus of hemorrhage in the left parafalcine region thought to represent subarachnoid versus intraparenchymal blood. Cerebral angiography demonstrated a narrow-necked 10.8 x 8.3 x 6 mm anterior communicating artery aneurysm and an incidentally noted wide-necked 3mm left middle cerebral artery bifurcation aneurysm. He underwent a right fronto-temporal craniotomy with clipping of the ACOM aneurysm and left front ventriculostomy placement on 7/20/2009. Repeat angiography demonstrated complete exclusion of the aneurysm. He made a full recovery and returned to work with some possible mild forgetfulness. The patient returned for elective clipping of the unruptured left MCA bifurcation aneurysm on 2/17/2010. He underwent left fronto-temporal craniotomy and the aneurysm was identified. However, according to the operative note, the patient abruptly went into ventricular tachycardia with loss of blood pressure followed by loss of pulse during final preparation for the clip application. CPR was initiated with multiple attempts at electrical and chemical cardioversion and a transvenous pacer was placed with no return of cardiac rhythm or blood pressure. A transesophageal echocardiogram was obtained and revealed no treatable causes. After one hour of cardiopulmonary resuscitation, the patient was declared dead at 13:16 hours on 2/17/2010.
