A 48-year-old woman is brought to the emergency department because of a 1-hour history of sudden-onset headache associated with nausea and vomiting. A CT scan of the head without contrast shows characteristics of subarachnoid hemorrhage. Over the next several hours, the patient gradually becomes somnolent and less responsive. She responses to painful stimuli only and does not follow commands. Repeat imaging of the brain shows no new hemorrhage, but there is enlargement of the entire ventricular system compared to the previous CT scan. Which of the following is the most likely cause of this patient's neurologic deterioration in the hospital?

Question

A 48-year-old woman is brought to the emergency department because of a 1-hour history of sudden-onset headache associated with nausea and vomiting. A CT scan of the head without contrast shows characteristics of subarachnoid hemorrhage. Over the next several hours, the patient gradually becomes somnolent and less responsive.  She responses to painful stimuli only and does not follow commands.  Repeat imaging of the brain shows no new hemorrhage, but there is enlargement of the entire ventricular system compared to the previous CT scan.  Which of the following is the most likely cause of this patient's neurologic deterioration in the hospital?

Quizplus · Accepted Answer

Eductional Objective: Communicating hydrocephalus is a common complication of subarachnoid hemorrhage that presents with deteriorating mental status.  It typically results from blood-induced impairment of absorption of cerebrospinal fluid by the arachnoid granulations.

A 48-Year-Old Woman Is Brought to the Emergency Department Because