Grade – 3, SAH and managemnet
Introduction:
Mrs. X, a 63-year-old female, was admitted to the hospital with complaints of sudden onset severe headache, vomiting, and decreased consciousness level. The initial examination revealed signs of subarachnoid hemorrhage (SAH) with a ruptured anterior communicating artery (ACOM) aneurysm and a large frontal hematoma. She had a medical history of coronary artery disease (CAD), hypertension (HTN), and chronic obstructive pulmonary disease (COPD). Dr. Rajiv Motiani, a neurologist with over 30 years of experience, was consulted for the patient’s further management. This case study aims to highlight Dr. Motiani’s contribution and dedication to the patient’s care.
Initial Assessment:
Upon admission, Mrs. X was immediately shifted to the ICU, and treatment was initiated as per standardized protocol. All necessary investigations were carried out, including a non-contrast CT (NCCT) scan of the head, which showed a metallic artifact in the supraclinoid on the left of midline with dense beam hardening artifacts (post aneurysmal coiling). Intraparenchymal hematoma with perifocal edema was seen parasagittally in the left frontal lobe, along with subarachnoid hemorrhage. Intraventricular extension of hematoma was seen in the occipital horns of both lateral ventricles. The rest of the brain parenchyma showed a normal sulcogyral pattern and attenuation. Basal ganglia and thalami were normal, and there was no midline shift or bony injury noted.
Treatment:
Dr. Nischint Jain, a neurointerventionist, was consulted for the patient’s grade 3 SAH, post-coiling, and frontal hematoma. Dr. Jain’s recommendations were followed accordingly. Mrs. X underwent aneurysmal coiling under general anesthesia on 07.04.2023. Post-operatively, she was shifted back to the ICU for further monitoring and management. Mrs. X was managed with strict blood pressure control, antiepileptics, and other supportive measures. She was kept on oxygen support to maintain her oxygen saturation levels. She was also started on prophylactic antibiotics and deep vein thrombosis (DVT) prophylaxis. The patient responded well to the management given, and her consciousness level gradually improved.
Management of Comorbidities:
Mrs. X had a medical history of CAD, HTN, and COPD. Dr. Motiani and his team monitored her vital signs closely and managed her comorbidities accordingly. Her blood pressure was controlled with intravenous (IV) antihypertensives. She was started on nebulization and inhalation therapy for her COPD. Her cardiac status was monitored closely, and appropriate measures were taken to prevent any complications. Dr. Hardik, a gastroenterologist, was consulted for the deranged liver function tests. He advised HbsAG, anti-HCV, IgM anti-HAV/HEV, and repeat LFT to be done. Her CBC and KFT were monitored on a routine daily basis.
Discharge:
Mrs. X responded well to the treatment given, and her neurological status improved. After the necessary investigations and treatment, Dr. Motiani deemed her fit for discharge. She was advised to follow up with her regular medications for CAD, HTN, and COPD. She was also advised to follow up with her neurologist regularly for further management of the SAH and hematoma. She was advised to avoid any strenuous physical activity, avoid driving for a few weeks, and to follow up with her physician immediately in case of any recurrence of symptoms.
Conclusion: Mrs. X’s case highlights the