Abstract
One-fourth of people with aneurysmal subarachnoid hemorrhage (SAH) die from the bleed suddenly in emergency rooms or before reaching hospital [1]. Unless medicolegal or medical autopsies are systematically performed to all sudden deaths, these SAH deaths are almost invariably classified as sudden cardiac deaths. The first observable symptom of sudden SAH death is loss of consciousness (LOC), which is also a common presenting symptom of non-fatal SAH. The pathophysiology of LOC at the time of aneurysm rupture is controversial. However, similar to sudden SAH deaths, the etiology of LOC in non-fatal SAHs is often considered to be cardiogenic. This presumption may, however, stem from the lack of evidence suggesting other etiologies. This report illustrates that a transient intracranial circulatory arrest associates with LOC and can occur without cardiac arrest. Furthermore, the case shows that patients experiencing a transient intracranial circulatory arrest can recover relatively well, despite the poor clinical status at the time of bleed. Clinical Presentation Reporting follows the CARE guideline [2]. According to the Finnish legislation, the patient consent is not required to use de-identified patient information for scientific purposes. Presenting Symptoms A 50- to 60-year-old ex-smoker with hypertension and asthma lost consciousness while playing sports. Bystanders performed cardiopulmonary resuscitation, and the patient regained consciousness in a couple of minutes.
Highlights
One-fourth of people with aneurysmal subarachnoid hemorrhage (SAH) die from the bleed suddenly in emergency rooms or before reaching hospital [1]
A vast increase in the intracranial pressure (ICP) at the time of loss of consciousness (LOC) is likely one of the major events that contribute to the beneficial formation of intra- and extraluminal thrombi, which aid to stop the bleeding from the ruptured aneurysm
The early CT angiography (CTA) scan demonstrated the regained intracranial circulation (Fig. 1b, Supplementary Video 2) and a suspicious posterior communicating aneurysm, which most likely was partially thrombosed at the time of imaging
Summary
One-fourth of people with aneurysmal subarachnoid hemorrhage (SAH) die from the bleed suddenly in emergency rooms or before reaching hospital [1]. The case shows that patients experiencing a transient intracranial circulatory arrest can recover relatively well, despite the poor clinical status at the time of bleed. The CTA scan showed intracranial circulatory arrest at the level of proximal middle and anterior cerebral arteries (Fig. 1a, Supplementary Video 1).
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