A 53-year-old man is brought to the emergency department by his wife for the evaluation of a progressively generalized headache that started suddenly 2 hours ago. He has not had any recent falls and was sitting in a chair when he lost consciousness. He has hypertension. Current medications include amlodipine, a daily multivitamin, and acetaminophen. Noncontrast CT scan of the head reveals diffuse hyperdensity in the subarachnoid space. CT angiography reveals a ruptured anterior communicating artery aneurysm. The patient is taken to the operating room for surgical clipping and transferred to the intensive care unit. Five days later, he has new-onset focal weakness of his left lower extremity. Repeat CT scan shows no significant changes. Which of the following is the most likely cause of this patient's neurological deterioration?

Question

A 53-year-old man is brought to the emergency department by his wife for the evaluation of a progressively generalized headache that started suddenly 2 hours ago. He has not had any recent falls and was sitting in a chair when he lost consciousness. He has hypertension. Current medications include amlodipine, a daily multivitamin, and acetaminophen. Noncontrast CT scan of the head reveals diffuse hyperdensity in the subarachnoid space.  CT angiography reveals a ruptured anterior communicating artery aneurysm.  The patient is taken to the operating room for surgical clipping and transferred to the intensive care unit. Five days later, he has new-onset focal weakness of his left lower extremity. Repeat CT scan shows no significant changes. Which of the following is the most likely cause of this patient's neurological deterioration?

Quizplus · Accepted Answer

Eductional Objective: The most common complication of aneurysmal subarachnoid hemorrhage is vasospasm, which typically occurs 3-12 days after the initial insult and can cause delayed cerebral ischemia (eg, sudden change in mental status, new focal neurological deficits).  The CT scan usually remains unchanged, unlike with rebleeding.

A 53-Year-Old Man Is Brought to the Emergency Department by His