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The Internet Journal of Emergency and Intensive Care Medicine ISSN: 1092-4051


Case of the Month: Case 3


Stephen Koch M.D.* Associate Professor, Departments of Anesthesiology* and Neurosurgery, Memorial-Hermann Hospital;University of Texas Medical School
Joseph L Nates M.D. Departments of Anesthesiology* and Neurosurgery, Memorial-Hermann Hospital;University of Texas Medical School

Citation:  S. Koch & J.L. Nates: Case of the Month: Case 3. The Internet Journal of Emergency and Intensive Care Medicine. 1999 Volume 3 Number 2

Keywords:  case of the month, emergency medicine, critical care, intensive care medicine, medicine, education, patient care, ventilation, cardiac, neuro, pediatric, cardio-pulmonary support, ards, respiratory failure, multiorgan failure, hemodynamics, intensivecare unit, surgical i

Abstract


Forty seven year old, black female, admitted with subarachnoid hemorrhage grade III. See CT brain below:

A four-vessel angiogram on admission to the emergency room showed multiple cerebral aneurysms and was transferred to our institution. Her past medical history included untreated arterial hypertension and chronic renal failure. On the second day, she was intubated due to respiratory distress. The same day, the patient underwent clipping of 2 of her 5 aneurysms (anterior communicating and right middle cerebral) without complications.


               The routine post-operative CT brain on day 8...

The routine post-operative CT brain on day 8...


               Was followed by this finding on day 15...

Was followed by this finding on day 15...

The above changes were associated with these physical changes:


               On the 12th day

On the 12th day


               On the 16th day

On the 16th day


               On the 18th day

On the 18th day


               On the 21st day

On the 21st day

  1. What is your diagnosis?

  2. What is the relation of this entity to syphilis?

  3. How are the findings of the CT (on the 15th) associated with this entity?

  4. What are the potential complications its therapy?


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