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A middle-aged man with a history of smoking and hypertension complains of acute onset severe headache and neck pain last night following the use of intranasal cocaine. On examination, HR 99 blood pressure 132/90 respiratory rate 22 SpO2 95% room air. He is alert but mildly agitated. His cranial nerve, motor-sensory, and funduscopic exams are normal. The remainder of his physical exam is unremarkable, except for mild meningismus. An emergent CT demonstrates an acute subarachnoid haemorrhage (SAH, figure 1). The patient develops increased work of breathing with a pulse oximetry reading of 92% on ambient air. A stat chest X-ray (figure 2) is obtained:
What does the X-ray show (figure 2)?
Given the rapid deterioration and X-ray, the patient is intubated, how can his ventilation be optimised?
Describe the Hunt–Hess Classification for SAH.
How does the World Federation of Neurological …
Contributors All authors contributed to the write-up of this case.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.