Sudden Onset Of Severe Headache Research Articles

SAT-246 A Case of Cabergoline Induced Pituitary Apoplexy in a Patient with Prolactinoma

ObjectiveTo report a case in which Cabergoline led to pituitary apoplexy (PA) in a young female patient with a macroprolactinoma.MethodsA 28 y/o F presented with 10 months of irregular menses followed by 6 months of amenorrhea. She reported a dull supranasal headache, and nipple crusting without obvious galactorrhea. She denied visual changes, dizziness nausea or vomiting. Her Prolactin (PRL) was elevated at 194ng/mL, and she was started on Cabergoline 0.25mg twice per week and sent for a pituitary MRI.Four weeks later, the patient presented to the emergency department with an acute worsening of headache after being found to have a pituitary hemorrhage on MRI. On PE there were no obvious neurologic deficits. Neurosurgery recommended no acute intervention and she was managed conservatively.ResultsLabs prior to Cabergoline: bHCG (-), PRL 194 ng/mL; LH 3.1 µIU/mL; FSH 4.9 µIU/mL; Estradiol <11 pg/mL; Cortisol 11.44 ug/dL; TSH 1.080 µIU/mL; Free T4 0.76 ng/dL. Labs after 1 month of Cabergoline treatment: PRL 84.3 ng/mL; FSH 2.2 µIU/mL; LH 2.8 µIU/mL; TSH 1.23 µIU/mL; FT4 0.82 ng/dL; Cortisol 15.43 ug/dL. MRI 1 month after Cabergoline was performed and showed a 1.4 x 1.4 x 1.5cm hemorrhagic mass of pituitary gland.DiscussionPA is the acute hemorrhage or infarction of the pituitary gland, commonly presenting with sudden onset of severe headache, visual field impairment, vomiting or altered mental status. However, like our patient, 25% of patients may present with subclinical apoplexy.Bromocriptine and Cabergoline are the two main treatments for prolactinoma. Both have been linked to PA, though the number of reports on Cabergoline is much less. There are now 10 cases of apoplexy reported with Cabergoline.PA can be spontaneous or precipitated by angiography, surgery, head trauma, hypertension, thrombocytopenia, diabetes, radiotherapy, coagulopathies, and Dopamine Agonists (DA). Most cases occur in older patients (50–60’s) with comorbidities, and incidence in patients <35 is rare.Moreover, PA is more common in males. Therefore, PA presenting in a young, healthy female suggests that Cabergoline may have been the precipitating factor.ConclusionIt is important to be aware that Cabergoline can precipitate PA in patients being treated for a Prolactinoma. We recommend a thorough history, physical exam and baseline imaging before starting Cabergoline therapy. We also recommend emergent imaging if there is an acute change in symptoms.

Takotsubo Cardiomyopathy Secondary to Ruptured Supraclinoid Internal Carotid Artery Aneurysm.

ABSTRACTA 41-year-old lady who presented with sudden-onset severe headache diagnosed to have ruptured supraclinoid internal carotid artery (ICA) aneurysm. Her cardiac echocardiography showed features of Takotsubo cardiomyopathy. After stabilizing her cardiac condition, she underwent craniotomy and clipping of aneurysm. Both cardiac and neurological catastrophes were managed by the joint team with excellent outcome. This paper emphasizes the need for high-quality combined care.How to cite this articleTripathy LN, Rana I, Saha A, Dixit R. Takotsubo Cardiomyopathy Secondary to Ruptured Supraclinoid Internal Carotid Artery Aneurysm. Indian J Crit Care Med 2020;24(5):363–364.

Prognostic Significance of Sentinel Headache Preceding Aneurysmal Subarachnoid Hemorrhage

Sentinel headache (SH) is often assumed to portend an increased risk of delayed cerebral ischemia (DCI) and aneurysm rebleeding. This study aimed to re-evaluate the associations between SH and aneurysm rebleeding, DCI, and outcome after SAH. We retrospectively analyzed 1102 patients with spontaneous SAH and available data regarding history of SH who were enrolled in the Columbia University SAH Outcomes Project between 1996 and 2009. Patients were asked whether they had experienced any episodes of acute, sudden-onset severe headache in the 2 weeks preceding the most recent bleeding event. DCI was defined as neurologic deterioration, infarction, or both due to vasospasm. Rebleeding was defined as the appearance of new hemorrhage on computed tomography. Outcome was assessed at 3 months by telephone interview using the modified Rankin Scale. SH was reported in 152 (14%) of 1102 patients. There were no significant differences between patients with and without SH with regard to admission Hunt-Hess grade or modified Fisher Scale. There was also no difference with regard to the frequency of aneurysm rebleeding (10% vs. 8%, P= 0.42), DCI (18% vs, 20%, P= 0.64), moderate-or-severe angiographic vasospasm on follow-up angiography (51% vs. 56%, P= 0.43), highest recorded mean middle cerebral artery flow velocity on transcranial Doppler (134 versus 128 cm/s, P= 0.30), or the distribution of modified Rankin Scale scores at 3 months. A history of sentinel headache before the clinical diagnosis of SAH does not imply an increased risk of DCI or further rebleeding, and carries no prognostic significance.

Skin manifestation and diagnosis of febrile diseases by COVID-19 and other ribonucleic acid viruses: The diagnostic clues

Many febrile diseases caused by ribonucleic acid virus infection demonstrate cutaneous manifestations with preceding prodromes. This review provides a flowchart highlighting the diagnostic clues of viral exanthem. Besides febrile prodromes, patients with chikungunya virus have severe arthralgias and macular hyperpigmentation on the noses. Coronavirus disease 2019 demonstrates unique acrocyanosis and pseudofrostbite besides erythematous rash and urticaria, suggesting abnormal coagulation. Dengue fever should be suspected when patients in the tropical region present with biphasic fever, headache, retroorbital pain, and centrifugal morbilliform rash. Dengue hemorrhagic fever, a potentially fatal complication, results from systemic vascular leakage. High-temperature fever and sudden-onset severe headache raise the possibility of Ebola virus infection. Patients with hand-foot-and-mouth disease may experience morbilliform or vesicular eruption, especially over the hands, feet, and oral mucosa. In acute human immunodeficiency virus infection, maculopapular eruptions often appear on the face and neck after prodromes. Primary human T-lymphotropic-III virus infection can induce widespread maculopapular or roseola-like exanthem, sparing the hands and feet. Cutaneous manifestations of rotavirus include generalized maculopapular rash, Sweet's syndrome, Henoch–Schonlein purpura, Gianotti–Crosti syndrome, and acute hemorrhagic edema. Rubella is usually suspected when low-grade fever and lymphadenopathy are accompanied by a discrete pinpoint-sized maculopapular rash, which spreads and diminishes faster than measles. Cough, coryza, and conjunctivitis followed by morbilliform eruptions and Koplik's spots are diagnostic of measles. Exanthem of Zika virus comprised of small pruritic papules that extend downwards. Laboratory testing is helpful in making a definitive diagnosis. Viral isolation, measurement of immunoglobulin M (IgM) or IgG, and/or reverse transcription polymerase chain reaction are useful diagnostic tools with favorable sensitivity and specificity.

An interdisciplinary approach to the treatment of a complex infraclinoidal internal carotid artery aneurysm

We present the case of a 49-year-old woman with sudden onset of severe headaches and a ruptured aneurysm located inside the fenestration of the infraclinoid part of the internal carotid artery in the segments C4 and C5 distal to the origin of the ophthalmic artery. An interdisciplinary approach enabled the successful treatment of the aneurysm by wrapping and stent-assisted coiling. We discuss this rare congenital anomaly of a fenestrated internal carotid artery together with the 12 other cases published worldwide.

Isolated fourth ventricle haemorrhage: “think beyond intracranial source’’ unusual presentation of lumbosacral spine arteriovenous malformation presentation

Spinal arteriovenous malformations (SAVMs) are rare vascular lesions and account for about 4% of primary intraspinal masses. Since SAVMs can involve any location along the spinal column and produce a host of different problems, the symptoms are extremely variable. There are few reports of simultaneous cerebral SAH and intraventricular hemorrhage (IVH) following rupture of a spinal AVM (SAVMs). Herein, we present a rare case of Lumbo Sacral spine arteriovenous malformation, which clinically manifests as sudden onset of severe headache and vomiting due to isolated fourth ventricle Hemorrhage (IVH) without cerebral subarachnoid hemorrhage.

A case of sentinel headache misdiagnosed: A catastrophe

Headache is the main complaint in outpatients consulting the neurologist and of adult patients presenting to an emergency department (ED) complaining of a headache. About a quarter of all patients presenting to the ED with a sudden-onset severe headache, described as the “worst of their lives,” have a subarachnoid hemorrhage. Patients may report symptoms consistent with a minor hemorrhage such as mild headache before a major rupture, which has been called a sentinel headache. Hereby, we describe a case of warning headache, an underestimated diagnosis.

Sudden Onset of Severe Headache with Psychotic Symptoms

Sudden Onset of Severe Headache with Psychotic Symptoms

Pediatric intracranial distal arterial aneurysms: report of 35 cases.

Although research on pediatric intracranial aneurysms is well documented, studies of pediatric intracranial distal arterial aneurysms (PIDAAs) remain scarce. All pediatric patients (≤ 18years) with intracranial aneurysms located distally to the M2 segment of the middle cerebral artery (MCA), A2 segment of the anterior cerebral artery, P2 segment of the posterior cerebral artery, and other cerebral arteries distal to the main branch who were treated at our center between January 2012 and April 2017 were retrospectively reviewed. Thirty-five PIDAAs were observed in 35 patients with a mean age of 9.2 ± 5.9years and a male ratio of 71.4% (n = 25). Sudden onset of severe headache was the most common symptom (n = 22, 62.9%), followed by seizures (n = 21, 60%). Twenty-seven patients (77.1%) had ruptured aneurysms, and 18 of them (66.7%) exhibited combined lobe intracerebral hematoma. MCA was the most common site (n = 23, 65.7%). Large or giant aneurysms were observed in 16 patients (45.7%). Eight patients (22.9%) had pseudoaneurysms, six of whom (75%) reported a head trauma history. Thirty patients (85.7%) had favorable outcomes at the end of the 6-month follow-up. Kaplan-Meier 6-month seizure curves revealed a significantly higher decrease in seizure rates in the surgical group than in the endovascular group (P = 0.036). PIDAAs constitute a high proportion of pediatric intracranial aneurysms. PIDAAs are associated with an increased risk of seizures, a predilection for the MCA, and a high incidence of pseudoaneurysms with head trauma history. Surgical intervention is of greater benefit than endovascular treatment in controlling the risk of seizures.

Multiple intracranial aneurysms and abdominal aortic occlusion in a young woman

Rationale:Multiple intracranial aneurysms occur in 10% to 30% patients with cerebral aneurysms.Patient concerns:We reported a case of multiple intracranial aneurysms concurrent with abdominal aortic occlusion (AAO) in a 29-year-old woman was admitted because of abrupt onset of severe headache, vomiting, and dizziness for 26 hours. She complained sudden onset of severe headache, vomiting, and dizziness.Diagnoses:Head computed tomography (CT) angiogram revealed 2 aneurysms of the anterior communicating artery (ACA) and a third aneurysm at the right middle cerebral artery (MCA). A diagnosis of multiple intracranial aneurysms concurrent with abdominal aortic occlusion (AAO) was made.Interventions:We clipped the 2 aneurysms at the ACA via a right pterional approach. The transfemoral approach failed because of an unsuspected AAO. A right carotid artery approach was then employed to embolize the aneurysm at the right MCA with three coils.Outcomes:Magnetic resonance angiography (MRA) at 7 days after the embolization demonstrated complete disappearance of all the intracranial aneurysms, but AAO was still present. The patient remained asymptomatic during 5-years of follow-up.Lessons:The case highlights the importance of a thorough physical examination, and in rare cases, AAO or other abdominal aortic abnormalities should be considered in young nonsmoking females. Successful treatment can be achieved by aneurysm clipping and embolization.

Spontaneous Subarachnoid Hemorrhage Induced by Warfarin Use

Introduction: The most frequent cause of spontaneous subarachnoid hemorrhage (SAH) is the rupture of a brain aneurysm. Approximately 5% of cases of spontaneous SAH did not show changes on magnetic resonance imaging (MRI) or angiography that explain such bleeding. The objective of this study was to report a case of spontaneous SAH induced by warfarin, where there was no evidence of any vascular malformation. Case Report: A 59 year-old male patient developed a sudden onset severe headache while in the shower. The patient had a history of mitral valve disease and valve replacement 23 years before and hypertension monitored by a cardiologist with 5 mg warfarin sodium daily. Computed tomography (CT) scan revealed a SAH. Laboratory tests showed an International Normalized Ratio (INR) of 2.22 (normal: 1 to 1.2). Cerebral angiography and neuraxis MRI were performed and showed no aneurysms or other vascular malformations. Conclusion: The occurrence of hemorrhageassociated with warfarin treatment is a well-documented event in the literature. However, the isolated occurrence of SAH in these patients is a rare event. To prove that SAH is indeed attributed to anticoagulation, it is necessary to excludethe presence of aneurysms and other vascular diseases by imaging techniques.

Gross Total Resection of Chordoid Glioma of the Third Ventricle via Anterior Interhemispheric Transcallosal Transforaminal Approach at Two Stages

Suprasellar tumors in particular tumors located in the retrochiasmatic area and anterior third ventricle are challenging cases in terms of optimal surgical exposure. Several approaches have been described including transsylvian, translamina terminalis, endoscopic endonasal, and anterior interhemispheric. Each approach has advantages and disadvantages. In this video, we present a case of retrochiasmatic anterior third ventricular tumor that was operated via anterior interhemispheric transcallosal transforaminal approach. The patient is a 42-year-old female who presented with sudden onset of severe headache and depressed level of consciousness. Computed tomography (CT) scan of the head showed a hemorrhage in the third ventricle and suprasellar cisterns. CT angiogram and magnetic resonance imaging (MRI) confirmed diagnosis of hemorrhagic mass lesion in the third ventricle. Upon further questioning of her family, we found out that she was having excessive urination and short-term memory problems for last 2 weeks. First, ventriculostomy was placed for obstructive hydrocephalus. She then underwent surgical resection via anterior interhemispheric transcallosal transforaminal approach. Foramen of Monro was enlarged by performing transchoroidal dissection. Using transforaminal route, tumor was resected. Due to the narrow surgical corridor and high vascularity of the tumor, decision was made to come back at a second stage. Using same surgical approach, in the second stage, gross total resection was performed. Postoperative MRI confirmed gross total resection. Histopathology was chordoid glioma of the third ventricle. She made excellent recovery with persistent diabetes insipidus. Currently, she is completing radiation therapy. In this video, we demonstrate techniques and pitfalls of anterior interhemispheric transcallosal approach to anterior third ventricular tumor. The link to the video can be found at: https://youtu.be/CI5c6Zup8sY .

Genetics of Intracranial Aneurysms.

Intracranial aneurysms (IAs) are localized dilatations of intracranial arteries that are because of weaknesses of the endothelial layer. These dilations vary in size (small aneurysms, 25 mm) and are classified according to their shapes: either localized sac-like pouches or long dilatations that increase the vessels diameter; these shapes are referred to, respectively, as saccular or berry aneurysms and fusiform aneurysms. Most IAs are saccular and typically occur at the arterial branching sites of the circle of Willis. Common sites of saccular IAs include the anterior communicating artery, the posterior communicating artery, internal carotid artery, the middle cerebral artery, and the basilar artery bifurcation. Although the exact pathogenesis of IA remains to be established, several hypotheses have highlighted the contribution of maladaptive vascular remodeling triggered by hemodynamic stress and inflammatory response1—a chain of events that would ultimately damage blood vessel walls and lead to IA. The worldwide prevalence of IA is estimated to be ≈3.2%.2 Subarachnoid hemorrhage (SAH) accounts for ≈5% of all strokes, and 85% of SAHs are because of aneurysmal ruptures. SAH has an incidence rate of 9 per 10 000 persons per year and a fatality rate ≈50%.3 The incidence of SAH is markedly higher in the Finnish and Japanese populations, but surprisingly, this is not because of the prevalence of IA in these populations.2 The most common clinical symptoms of aneurysmal SAH are a sudden onset of severe headache with stiff neck, vomiting, and photophobia. Unruptured IAs are usually asymptomatic and are identified through the screening of high-risk individuals or as incidental findings of magnetic resonance imaging, particularly magnetic resonance angiogram, or computerized tomographic studies. The diagnosis of IA is made by magnetic resonance angiogram, computerized tomographic angiography, or classical angiography. The diagnosis of …

Cerebrospinal fluid features in adults with enteroviral nervous system infection

ObjectivesThe aim of this study was to investigate the clinical and laboratory features of adults with nervous system infections caused by enteroviruses, with special emphasis on cerebrospinal fluid (CSF). MethodsThe data of 46 patients who were PCR-positive for enteroviruses in the CSF between 2002 and 2017 were evaluated. ResultsMeningitis was the most common clinical manifestation (89%), followed by encephalitis (7%) and isolated cranial nerve involvement (4%). Twenty percent of patients reported a sudden onset of severe headache that led to the initial suspected diagnosis of subarachnoid haemorrhage. General signs of infection, such as fever, elevated C-reactive protein, and an elevated white blood cell count, were found in only 61%. Most patients exhibited consistent inflammatory CSF changes, with elevated cell counts (85%) and blood–CSF barrier dysfunction (83%). Patients with normal CSF cell counts were significantly older, less frequently presented with meningitis, and exhibited lower peripheral white blood cell counts. Sequencing revealed species Enterovirus B in all patients, with most sequences related to echovirus 30. ConclusionsThe absence of CSF pleocytosis, isolated cranial nerve involvement, and only infrequent general signs of infection may impede the diagnosis of enteroviral nervous system infections. A thorough CSF analysis including PCR is essential for a reliable diagnosis.

Retropharyngeal tendinitis: Hydroxyapatite deposition driven headache and nuchal rigidity resolves with prednisone

We present a case of a 42-year-old woman who presented with sudden onset severe headache, neck pain, and nuchal rigidity associated with dysphagia. The initial differential in this patient included meningitis or retropharyngeal abscess, and an extracranial neck CT showed an ill-defined hypo-attenuated lesion within the retropharyngeal space. However, the neck pain and dysphagia were unresponsive to empirical antibiotic treatment and pain management. Further CT with contrast identified acute calcific tendonitis of the longus colli tendon, also known as retropharyngeal tendonitis (RCT). Although RCT is already known as a rare, self-limiting inflammatory condition, we present a new case of RCT, with the uncommon features of headache and nuchal rigidity in an aseptic patient, while providing a diagnostic flow chart to guide the clinical work-up of similar presentations to also include RCT.

Self-thrombosing anterior cerebral artery aneurysm leading to a caudate infarct

Abstract Self-thrombosing intracranial aneurysms are relatively uncommon and the conditions that lead to their formation are unknown, although they can be seen following subarachnoid hemorrhage and in autopsy specimens. We seek to raise awareness of the unintended iatrogenic thrombosis of intracranial aneurysms, its ischemic consequences, and the use of mechanical thrombectomy in its treatment. A 50-year-old hypertensive woman presented with a sudden onset of severe headache concerning for a ruptured cerebral aneurysm (Hunt-Hess 2). HCT showed diffuse subarachnoid hemorrhage (modified Fisher grade 3), and CTA showed two aneurysms arising from an anterior communicating (ACOM) complex fenestration and one aneurysm arising from the proximal left anterior cerebral artery (ACA) A1 segment. Successful coil embolization of the distal ACOM aneurysm was followed by an attempted balloon-assisted coil embolization of a left ACA A1 aneurysm that led to self-thrombosis and partial occlusion of the A1 segment. After mechanical thrombectomy, there was significant reduction in left A1 thrombus burden. The patient developed an asymptomatic small infarct of the left caudate, likely by occlusion of an anatomic variant of the recurrent artery of Heubner arising from the A1 segment. To our knowledge, this is the first reported case of a self-thrombosing aneurysm during attempted balloon-assisted embolization. Propagation of the thrombus can lead to parent vessel occlusion and ischemia, and, in this case, an anatomic variant of the recurrent artery of Heubner from A1 made this more likely. Intra-arterial mechanical thrombectomy may be used in the treatment of an iatrogenic vessel thrombosis.

Complete ophthalmoplegia, complete ptosis and dilated pupil due to internal carotid artery dissection: as the first manifestation of Takayasu arteritis

BackgroundTakayasu arteritis is a rare, chronic large vessel vasculitis involving the aorta and its primary branches. As the disease progresses, the active inflammation of large vessels leads to dilation, narrowing and occlusion of the arteries. Arterial dissection is due to separation of the layers of the arterial wall resulting in a false lumen, where blood seeps into the vessel wall. Neurological sequelae of intracranial arterial dissection results from cerebral ischemia due to thromboembolism and hypo perfusion. Internal carotid artery dissection in Takayasu arteritis is very rare and complete ophthalmoplegia due to internal carotid artery dissection is also rare. This is the first case report of Takayasu arteritis presenting as complete ophthalmoplegia due to internal carotid artery dissection.Case presentationA 38-year-old Sri Lankan female presented with sudden onset severe headache, fixed dilated pupil, complete ptosis and ophthalmoplegia on the right side. On imaging, dissection and dilatation was evident in the right internal carotid artery from the origin up to the cavernous segment. She also had stenosis and aneurysmal dilatation of right subclavian artery. Takayasu arteritis was diagnosed subsequently. She was started on aspirin and high dose steroids.ConclusionsInternal carotid artery dissection within the cavernous sinus can lead to third, fourth and sixth nerve palsy due to compression, stretching and ischemia from occlusion of the nutritional arteries. This case report illustrates that internal carotid artery dissection should be a differential diagnosis in palsies of the third, fourth, or sixth cranial nerves, especially when associated with headache. In cases of internal carotid artery dissection, vasculitis such as Takayasu arteritis should also be considered.

Presenting Symptoms of Pituitary Apoplexy.

The classical term "pituitary apoplexy" (PA) describes a clinical syndrome usually characterized by abrupt onset of headache accompanied by neurologic and/or endocrinologic deterioration due to sudden expansion of a mass within the sella turcica as a result of hemorrhage or infarction within a pituitary tumor and adjacent pituitary gland. PA is a medical emergency and a difficult diagnosis to establish. Thus this article reviews the presenting symptoms of PA patients to help clinicians recognize or at least suspect this critical condition early on. PA commonly occurs in the setting of a preexisting adenoma, and several patients are unaware of its existence prior to the onset of apoplexy symptoms, which are mainly of a neurologic, ophthalmologic, and endocrinologic nature. Neurologic symptoms include sudden-onset severe headache and other symptoms of subarachnoid hemorrhage, symptoms from compression of the cavernous sinus contents, nausea/vomiting, impaired consciousness, and symptoms of meningeal irritation. Ophthalmologic symptoms include visual field defects, visual loss, diplopia, and ophthalmoplegia. Endocrinologic disturbances include pituitary adenoma symptoms, cortisol deficiency, panhypopituitarism, diabetes insipidus, and syndrome of inappropriate secretion of antidiuretic hormone. Magnetic resonance imaging is the imaging method of choice to aid the PA diagnosis. Its differential diagnoses include cerebrovascular accidents, infectious diseases, and other causes of endocrinologic imbalance. Transsphenoidal surgery is the treatment of choice, especially if there are associated visual abnormalities and ophthalmoplegia. Clinicians should be aware of the presenting symptoms because early diagnosis may reduce the morbidity and mortality of this neurosurgical emergency.

Testicular Tuberculosis with Tuberculoma of Brain in an HIV Negative Patient

Isolated testicular tuberculosis without renal or pulmonary involvement has not been reported much earlier. The case of a young HIV negative patient with testicular tuberculosis and tuberculoma of brain has been presented. A 32 years old normotensive, non-diabetic farmer presented to emergency facility with sudden onset of severe headache, vertigo and vomiting that developed over 24 hours and mild pain, swelling of right hemiscrotum associated with low grade fever for last one month. On examination, patient was conscious, oriented, pulse rate was 72/min, blood pressure was recorded 130/80 mm Hg, body temperature was 99 degree F, genital examination revealed swelling of right hemiscrotum with enlarged, firm and mildly tender right testis. He refused full neurological examination due to severe Journal of Bangladesh College of Physicians and Surgeons Vol. 34, No. 2, April 2016 headache and vertigo. MRI of brain revealed multiple, hyperintense, ring-enhancing lesions over right cerebellar hemisphere and corpus callosum. Aspiration of scrotal fluid revealed about 50 ml of yellowish pus, microbiology confirmed presence of few acid-fast-bacilli and plenty of pus cells. FNAC from right testicular mass revealed presence of granuloma and caseation necrosis. His chest X-ray and CSF analysis were normal, ESR was 20, USG of abdomen, hepatic and renal work-up was normal. Soon the patient was started with category I antituberculosis drug along with intravenous steroids. An excellent symptomatic improvement developed on 5th day of initiating drug therapy, he was closely monitored and followed up after discharge. This case report was prepared with his full consent.J Bangladesh Coll Phys Surg 2016; 34(2): 112-114

Intracranial hemorrhage from giant aneurysm in pregnancy: A rare association

We report a case of giant aneurysm causing subarachnoid hemorrhage in a pregnant female. A 25-year-old female presented with sudden onset of severe headache and vomiting with altered sensorium and right hemiplegia. On investigation, she had a giant supraclinoid segment internal carotid artery (ICA) aneurysm. She was planned for digital substraction angiography, but during the procedure she deteriorated neurologically and went into spontaneous labor. The baby was a male child with weight of 1.1 kg. She was taken up for surgery and aneurysm was clipped. We discuss the rare occurrence of intracranial hemorrhage in pregnancy due to a giant ICA aneurysm.