Undiagnosed Brain Aneurysm Ruptures, Results in Death

Case Overview

This case involves a generally healthy and active forty-five-year old male with a history of multiple sclerosis. The patient experienced a syncopal episode overnight while attempting to urinate. As a result, the patient fell and sustained a blow to the back of the head, losing consciousness. The patient’s wife called their primary care physician to see if she should bring him to the emergency room and the doctor said that it was fine to just observe him closely. Over the next few days, the patient complained of headaches and extreme nausea. The patient was sent for an MRI that indicated a suspicious spot indicative of an aneurysm in the region of the anterior communicating artery, but no further testing or follow-up was conducted. Several months later, the patient was found by his wife on the floor of the bedroom displaying seizure like activity. He was rushed to the ER. The patient was diagnosed with a subarachnoid hemorrhage and was transferred to a tertiary care hospital for emergency surgery. Upon transfer, the patient was then diagnosed with a ruptured anterior communicating artery aneurysm and a micro surgical clipping of the anterior communicating artery with a ventriculostomy was performed. Despite the intervention, the patient remained in a coma for most of the hospitalization. He eventually regained consciousness, but he suffered intractable brain damage, which caused severe paralysis and memory loss. He was transferred from acute rehabilitation to a nursing home, where he remained until his death two years later.

Questions to the Neuroradiology expert and their responses

How familiar are you with clinical situations like the one described above?

I am very familiar with clinical scenarios such as this and the hospital care should begin with assessment of vital signs and neurological status.

Would earlier intervention and a more thorough workup have resulted in a better outcome?

Certainly, earlier intervention would have resulted in a more desirable outcome. However, I will need to know more about this patient's presentation to determine if the workup was adequate or not.

About the expert

Attended the US Air Force Academy in Colorado Springs, Marshall University, and the Marshall University School of Medicine. Completed a residency in diagnostic radiology at the University of Virginia Medical Center and a fellowship in neuroradiology at the University of Virginia. Joined the staff at the University of Virginia Health System Division of Neuroradiology as an assistant professor, and progressed to Full Professor and Director of the Division of Neuroradiology, Vice Chair of Finance of the Department of Radiology, and Director of the Neuroradiology Fellowship program. Active member of the American College of Radiology, the Radiological Society of North America, the American Society of Neuroradiology, American Society of Head and Neck Radiology, the American Roentgen Ray Society, the Southeastern Neuroradiology Society, and the Association of University Radiologists. ASNR representative to the AMA CPT Editorial Committee, and serves on the ASNR Economics Commission.

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Specialties:

Neuroradiology