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Subarachnoid hemorrhage presenting an "abnormal movement"--case report

K Hongo¹, M Mizuno, S Oikawa

¹Department of Neurosurgery, Shinshu University School of Medicine, Nagano.

Neurologia Medico-Chirurgica

|August 1, 1993

Summary

A rare case of subarachnoid hemorrhage presented with unusual rhythmic movements. Surgical clipping of the aneurysm resolved the symptoms, suggesting intracranial pressure as the cause.

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Area of Science:

Neurology
Neurosurgery
Vascular Neurology

Background:

Subarachnoid hemorrhage (SAH) is a critical neurological condition often caused by ruptured cerebral aneurysms.
Abnormal movements are uncommon initial presentations of SAH.

Observation:

A 61-year-old male experienced a 10-minute episode of rhythmic abnormal movements preceding SAH diagnosis.
The movement involved synchronized tongue protrusion/eye opening and tongue retraction/eye closing.
Neuroradiology revealed a small aneurysm as the source of the hemorrhage.

Findings:

The abnormal movements ceased permanently after surgical aneurysm clipping and clot evacuation.
The transient increase in intracranial pressure during the initial hemorrhage was hypothesized as the etiology for the movements.

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Implications:

This case highlights an unusual presentation of SAH, emphasizing the need for comprehensive neurological assessment.
It suggests a potential link between acute intracranial pressure fluctuations and transient paroxysmal movement disorders.
Effective surgical management of the underlying vascular lesion resolved the paroxysmal symptoms.