CEREBRAL ANEURYSM

A 28 years old woman was brought to hospital, because she suddenly loss her consciousness. On her way to the hospital, the level of consciousness decreased.
Whens she arrived, she could still move her extremities spontaneously. I suspect a Haemorrhagic stroke happen to this patient with a big chance of aneurysm or arteriovenous malformation. Still, the patient came in a very severy condition.
The patient got brain ct scan, and as suspected there was bleeding inside her brain. Unfortunately, the bleeding was happened in her pons which was her brain stem and it only meant very bad prognosis. There is subarachnoid bleeding also which meant there was ruptured aneurysm possibly basilar aneurysm. Worst case.
The level of consciousnes was deteriorating that the patient fell into deep coma and need intubation to preserve her breathing. Consultation with neurosurgeon and no surgery in consideration due to the location of the bleeding, not even clipping or embolization of the aneurysm.
She was sent to ICU and was knocked down to avoid more cerebral swelling. Eventually there was infection, so antibiotic was prescribed to her. Her temperature raising to 40 degree celcius, made the brain worse. Infusion with Nimodipine and giving analgetic could only help a little in this patient.
Today is her 4th day of hospitalization. The condition of the patient deteriorating, I hope she could survive, but in this case I had to tell her husband and family the worst case that might happen to her.
We could only give our best to save her. Everything else depend on God's hand.

What is SUBARACHNOID HAEMORRHAGE?
It is a cerebrovascular disease, a Haemorrhagic stroke, usualy due to AVM or aneurysm.
The earliest symptom of patient with SAH is severe headache, the worst one, thunder-clap headache, then follow by neck stiffness and decrease level of consciousness. Aneurysm is the common cause of haemorrhagic stroke in young age. When it happen in basilar artery, the consequence is devastating like this patient, bleeding in the brain stem can easily end up in mortality.

Can we avoid it?
Not hundred percents. We could be careful though if we had frequent headache that worsen by days. But nothing specific could differentiate it.

What is the treatment?
The treatment comprise of two front, to treat the vascular anomaly and to salvage the brain. Both must be done at the same time. While clip on or embolize the aneurysm, we should do what we call triple H therapy consist of hypertension, hypervolemia and haemodilution.

This case is the worst one. Only miracle could save her from her disease. Again I really hope she could survive.