Concluded Case

ANEURYSMAL SAH

69/M presented today at around 9pm with acute onset severe headache which progressed to loss of consciousness.H/o HTN on irregular treatment,Chronic smoker. Pupils - B/l 4mm NRTL,GCS -E1V1M2,BP -200/100. INTERPRET CT SCAN HEAD? FISCHER GRADE??

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Concluded answer
Diffuse Subarachnoid hemorrhage with interhemispheric extension of hemorrhage and also in the posterior horn of lateral ventricles which makes a FISCHER (modified ) grade 4 . A hypertensive bleed most likely Aneurysmal ( ACOM) rupture with non - communicating hydrocephalus.. Start with conservative treatment with gradual lowering of B.P with labetalol in drip, AED , ventilatory support , decongestive therapy with mannitol. Surgical options are . 1.Clipping or endovascular treatment for aneurysm . 2.External ventricular drainage or ventriculostomy for hydrocephalus
All Answers
Diffuse Subarachnoid hemorrhage with interhemispheric extension of hemorrhage and also in the posterior horn of lateral ventricles which makes a FISCHER (modified ) grade 4 . A hypertensive bleed most likely Aneurysmal ( ACOM) rupture with non - communicating hydrocephalus.. Start with conservative treatment with gradual lowering of B.P with labetalol in drip, AED , ventilatory support , decongestive therapy with mannitol. Surgical options are . 1.Clipping or endovascular treatment for aneurysm . 2.External ventricular drainage or ventriculostomy for hydrocephalus
Valuable opinion
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Aneurysmal SAH.. poor GCS so no indication of definitive treatment unless patient survives this bleed.. the aneurysmal detection and blockage protocol is to prevent second bleed..t doesn't help in recovery of the one that has happened
Valuable opinion
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Diffuse SAH ,anterior interhemispheric blood,blood in the posterior horn of both lateral ventricles with early hydrocephalus Suggest CTA / DSA to exclude ACOM aneurysm. Grade4.
Valuable opinion
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Probably ACom aneurysm rupture with SAH with 2ndry hydrocephalus non communicating type Left frontal area hemorrhage present B/l lateral ventricle IVH
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SAH with IV extention modified fisher scale grade 4 MRA to be done,if indicated surgical intervention

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