Case study 3: Murray—Seeing black spots
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A 78 y/o male with a history of HTN presents to the ER a week after he was discharged following emergent neurosurgical management of a ruptured Berry aneurysm. He says he’s seeing “black spots” and has had a worsening headache for the past day or so.
His past medical history is significant for hypertension and type II diabetes.
His past medical history is significant for hypertension and type II diabetes.
Question
What is the most likely etiology of his worsening headache?
The patient is most likely experiencing a cerebral vasospasm due to subarachnoid hemorrhage in the setting of a ruptured Berry aneurysm. This is a well-documented complication of subarachnoid hemorrhage and can present insidiously, up to 21 days after the original hemorrhage (3–7 days most common).
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