Concluded Case

Saccular aneurysm at the origin of PCOM with grade lV S AH.

New case 73 yr ,F ,known hypertensive since 38 yrs ,developed abrupt onset of head ache with vomiting and soon became unconcious. Immediately take to local hospital ,intubated and mechanically ventilated and then transferred. On exam BP on arrival at ER 170/ 100mmhg,HR 42 / my.Deeply sedated . Left pupil8mm,nonreacting rt popular 4mm,sluggishreaction on direct light. Detailed neurological evaluation is not possible ,since she I'd sedated and medically paralyzed. The interval between the onset and arrived the ER took 7 hrs and 40 mts. URGENT CT WITH CTA DONE. Pt deteriorated during the procedure and resuscitation done as per ACLA protocol,unfortunately she expired Diagnosis and prognosis if arrived early?.

LikeAnswersShare
Concluded answer
Thanks for all answeres. Diagnosis PCOM abeurysm with grade lV SAH.Even if come early, expected prognosis is unpredictable, ie poor prognosis MRI report : Grade 4 diffuse SAH involving bilateral lateral cerebellomedullary junction,bilateral CP angle cisterns ,prepontine,premedullary cisterns, ambient ,quadrigeminal and rural cisterns, perichiasmatic cistern, bilateral sylvian fissure and interhemispheric fissure and adjacent sulci. * Diffuse cerebral edema noted. * Wide- necked saccular aneurysm involving the site of origin of PCOM in the left ICA communicating segment.
All Answers
Thanks for all answeres. Diagnosis PCOM abeurysm with grade lV SAH.Even if come early, expected prognosis is unpredictable, ie poor prognosis MRI report : Grade 4 diffuse SAH involving bilateral lateral cerebellomedullary junction,bilateral CP angle cisterns ,prepontine,premedullary cisterns, ambient ,quadrigeminal and rural cisterns, perichiasmatic cistern, bilateral sylvian fissure and interhemispheric fissure and adjacent sulci. * Diffuse cerebral edema noted. * Wide- necked saccular aneurysm involving the site of origin of PCOM in the left ICA communicating segment.
Most likely aneurysmal bleed from left internal carotid artery supraclinoid portion. Requires urgent surgical decompression and clipping. This is possible only in a small percentage of the patients who are stable and all investigation can be carried out.
Dilation of vein seen in ct Because of that there will be severe internal bleeding and that might raise ic pressure It might also lead to thrombosis Because of paralysing the patient it may also lead to respiratory distress
Thank you doctor
0
3rd nerve compression, hydrocephalus and acute SAH, poor prognosis ma'am unfortunately such patients due to poor gcs score and the underlying causes don't have good prognosis generally and will be having neuro deficits
Poor fella, Such a severe SAH with IVH, ruptured Pcom aneurysm with 3rd nerve compression acute hydrocephalus
I agree
0
Acute subarachnoid hemorrhage and atherosclerosis carotid and right MCA

Cases that would interest you