Hemorragia Subaracnoidea por Ruptura de Aneurisma Sacular

Abstract

Subarachnoid hemorrhage is the output of blood into the subarachnoid space, and is considered a neurological emergency because it has a high morbidity and mortality. Its incidence is about 10 cases per 100,000 population per year, hypertension and smoking are the main risk factors. 80% of subarachnoid hemorrhages, are secondary to rupture of cerebral aneurysms, the remaining 20% is due to arteriovenous malformations (AVM), illicit drugs, amyloid angiopathy and superficial siderosis, venous sinus thrombosis, arterial dissection, infections, coagulation disorders, pituitary apoplexy and head trauma. The diagnostic study of choice is computed tomography (CT) without contrast. Treatment should be performed in specialized centers, embolization of unruptured aneurysms is recommended as a minimally invasive treatment as it is associated with low morbidity and mortality.

A clinical case of a patient of 69 years with no personal or family history of importance Subcentro entering the health of La Mana because 15 days ago headache presents spontaneous appearance of holocraneana location, high intensity described by scale 9/10 EVA described as the "worst headache of your life" without irradiation does not relieve any position and spontaneous exacerbation and suffers fainting approximately 30 seconds plus classic symptoms of pyelonephritis include fever, it chills, back pain, dysuria and polaquiuria so comes to health Subcentro La Mana where she underwent additional tests the diagnosis is confirmed and transferred to Latacunga IESS Hospital where diagnosed with pyelonephritis is administered antibiotics, hydration and analgesia.

On his second day of hospitalization patient referred headache of moderate intensity scale 8/10 as continuous type EVA holocraneana not giving up on painkillers, decided to perform CT brain where there are signs of subarachnoid hemorrhage, so it was decided to perform CT angiography in CT angiography shift awaiting new headache patient has high intensity and fading staying with a 14/15 Glasgow you choose to make new brain CT where volume increase bleeding is observed and decides to transfer to a third level unit.

In third level unit angiography shows presence of saccular aneurysm and decided to perform embolization, on the eighth day of hospitalization treatment as expected, suffers new event being in Glasgow 7/15 it was decided to transfer to ICU where patient dies.