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- Jennifer E Fugate, Grant W Mallory, and Eelco F M Wijdicks.
- Division of Critical Care Neurology, Mayo Clinic, Rochester, MN 55905, USA. fugate.jennifer@mayo.edu
- Neurocrit Care. 2012 Dec 1;17(3):439-40.
BackgroundEarly secondary neurologic deterioration after aneurysmal subarachnoid hemorrhage (SAH) may have many causes including rebleeding, hydrocephalus, parenchymal hematoma, or seizures.MethodsCase report.ResultsA 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.ConclusionsSudden 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.
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