Ultra-early aneurysmal rebleeding and brainstem destruction

Neurocrit Care. 2012 Dec;17(3):439-40. doi: 10.1007/s12028-011-9648-y.


Background: Early secondary neurologic deterioration after aneurysmal subarachnoid hemorrhage (SAH) may have many causes including rebleeding, hydrocephalus, parenchymal hematoma, or seizures.

Methods: Case report.

Results: A 69-year-old woman presented with thunderclap headache and nausea. A head computed tomography (CT) showed SAH. On initial evaluation she was awake, alert, and confused without focal neurologic deficits. Two episodes of marked clinical deterioration occurred, manifesting as acute unresponsiveness and fixed anisocoria. Serial head CTs showed massive extension of hemorrhage into the brainstem parenchyma and ventricles.

Conclusions: Sudden clinical deterioration after SAH with coma and a fixed "blown" pupil may result from hemorrhage extension into the brainstem parenchyma rather than oculomotor nerve injury from compression or stretch.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anisocoria / diagnostic imaging
  • Brain Stem / blood supply*
  • Brain Stem / diagnostic imaging*
  • Coma / diagnostic imaging*
  • Disease Progression
  • Female
  • Humans
  • Recurrence
  • Subarachnoid Hemorrhage / diagnostic imaging*
  • Subarachnoid Hemorrhage / surgery
  • Tomography, X-Ray Computed
  • Ventriculostomy