A 50 year old smoker comes in with severe headache, altered mentation, and this CT scan. He goes to interventional radiology for a procedure. Over the next several days, he slowly improves. A week later, though, he suddenly gets worse. He becomes more confused and somnolent. CT and EEG do not explain his neurologic exam. Ultrasound confirms the diagnosis.
Challenge: What do you suspect?
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Delay
This is vasospasm and delayed cerebral ischemia seen 3-21 days after a subarachnoid hemorrhage. Transcranial doppler can be used to identify potential vasospasm.
Source: UpToDate; openi.nlm.nih.gov.
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