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Aneurysmal subarachnoid hemorrhage presenting as cardiorespiratory arrest
Archives of Internal Medicine
|September 1, 1987
Summary
Subarachnoid hemorrhage from ruptured aneurysms can cause sudden cardiac or respiratory arrest. Delayed diagnosis of subarachnoid hemorrhage (SAH) in patients with cardiac arrest significantly impacts outcomes, highlighting the need for prompt neurological investigation.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH), often caused by ruptured berry aneurysms, presents a critical neurosurgical emergency.
- Sudden cardiac or respiratory arrest can be a presenting manifestation of SAH, complicating patient management and prognosis.
Observation:
- This report details three cases of SAH due to ruptured aneurysms.
- Two patients experienced cardiac arrest, with delayed SAH diagnosis correlating to poor outcomes despite resuscitation.
- A third patient presented with irreversible respiratory arrest.
Findings:
- SAH can trigger life-threatening cardiac arrhythmias and respiratory arrest through various proposed mechanisms.
- Early recognition of SAH is crucial, even in the absence of prior cardiac history.
Implications:
- Clinicians should maintain a high index of suspicion for SAH in patients with sudden cardiac/respiratory arrest.
- Key warning signs include persistent headache, focal neurological deficits, papilledema, or subhyaloid hemorrhages, necessitating urgent neurological evaluation.