Bruno Babeli, 2nd year, 2022./23.

Case report

PATIENT INFO

Name: Jane Doe

Age: 45 years old

Sex: Female

PRESENT COMPLAINT

Patient complains of sever migraines, which started 2 days ago, with increasing severity located on
the back of the head and radiating to the forehead.

Accompanying symptoms include photophobia, nausea, and vomiting.

MEDICAL HISTORY (immediate, past)

Patient has a recent diagnosis of hypertension and has a history of recurring migraines.

POINTS OF NOTE

Patient admits taking over-the counter medication for pain relief but with little effect on her migraine.

O/E (on exam)

Physical examination revealed a dehydrated, distressed woman with BP of 180/120 mm Hg, pulse of
110 BPM, and body temperature of 36.1°C. There were no neurologic deficits.

INVESTIGATIONS / LAB EXAMS / DIAGNOSTIC TESTS/PROCEDURES

A computed tomography (CT) scan of the head showed a subarachnoid hemorrhage.

DIAGNOSIS

Subarachnoid hemorrhage of anterior and posterior cerebral artery.

TREATMENT / MANAGEMENT / HOSPITAL COURSE

The patient was admitted and underwent cerebral angiography two days later, which demonstrated
multiple aneurysms. Aneurysm repair surgery was performed which included front parietal
craniotomy and suprasellar clip. Postoperatively the patient remained unconscious and required
mechanical ventilation. Her condition continued to deteriorate. After a nuclear brain scan
demonstrated absence of blood flow to the brain, which was likely caused by bilateral compromise of
anterior cerebral artery postoperatively, the patient was pronounced brain dead.

References: Guthrie G, Rivas K. Case report: subarachnoid hemorrhage in woman with migraines.
Am Fam Physician. 2009 Mar 1;79(5):374, 376. PMID: 19275066.