Subarachnoid hemorrhage and hydrocephalus

Case contributed by Dr Craig Hacking

Presentation

Occipital headache. Now GCS 3. Intubated.

Patient Data

Age: 85 years
Gender: Female

The non-contrast study demonstrates a large volume of intraventricular hemorrhage and marked ventricular enlargement even allowing for the patient's age. Intraventricular hemorrhage is seen in all the ventricles and extends into the sylvian fissures and basal cisterns. There is sulcal effacement particularly inferiorly with early loss of normal grey-white matter differentiation. No cerebellar tonsillar herniation.

A slightly hyperdense suprasellar mass measures ~3cm which is likely a giant aneurysm of the anterior circulation and the cause for the intraventricular hemorrhage.

Conclusion

Large volume intraventricular hemorrhage with hydrocephalus. The hemorrhage is likely secondary to a ruptured giant anterior circulation aneurysm.

Case Discussion

A CTA performed subsequently was of poor quality due to impaired perfusion and suboptimal timing, but confirmed presence of a giant suprasellar aneurysm. The patient's family elected for palliative treatment and the patient died peacefully 2 days later. Autopsy was not performed.

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Case information

rID: 37854
Published: 26th Jun 2015
Last edited: 27th Sep 2017
Inclusion in quiz mode: Included

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