Presentation
Thunderclap headache; reduced GCS
Patient Data
Large-volume subarachnoid hemorrhage within the sulci and basal cisterns. High-density hemorrhage within the third ventricle with ballooning of the temporal horns in keeping with hydrocephalus.
High-density crescentic, dependent hemorrhage layering in both globes is in keeping with retinal hemorrhage.
Case Discussion
This patient presented with classic symptoms of subarachnoid hemorrhage—severe thunderclap occipital headache—and then a severe drop in the Glasgow Coma Scale (GCS). The CT scan on arrival at the hospital is shown above and demonstrates Terson syndrome—retinal hemorrhage. The mechanism for this may relate to increased intracranial pressure.
While the condition can be managed operatively if it fails to resolve, this patient died secondary to the subarachnoid hemorrhage, and no follow-up imaging was performed.
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