The Real-World Boards: Question #12
A 42-year-old woman with aneurysmal subarachnoid hemorrhage becomes unresponsive
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A 42-year-old woman presents to the ED with severe headache and is found to have a ruptured anterior communicating artery aneurysm. She undergoes successful coil embolization and is admitted to the ICU. She later becomes unresponsive and is intubated.
On hospital day 3, she begins to withdraw from painful stimuli; the remainder of her neurologic exam is stable. Pupillary and other cranial nerve reflexes are present but weak.
On hospital day 5, she is febrile to 38.7 °C, with an elevated white blood cell count at 15K, and no longer localizes to pain. Pupils are equal and remain poorly reactive. Noncontrast head CT shows enlargement of the ventricles.
