Systemic Complications of Subarachnoid Hemorrhage: A Case Report

Abstract

Spontaneous aneurysmal subarachnoid hemorrhage is a cause of mortality and severe disability. Patients with subarachnoid hemorrhage may develop systemic complications, which may affect outcome. This clinical case aims to describe and discuss the case of a 41-year-old male who was diagnosed of subarachnoid hemorrhage due to the rupture of an aneurism located in the bifurcation tract of the right middle cerebral artery. The patient was transferred to the referring hub center to undergo neurosurgical treatment. Upon sedation and mechanical ventilation, the patient was admitted to the intensive care unit. Forty-eight hours thereafter, a new brain computer tomography was negative for postsurgical complications, and the patient was extubated. In a few hours, the gas exchange worsened, and the patient needed again intubation and mechanical ventilation, with a chest computer tomography diagnostic for pulmonary embolism. The echo color Doppler of deep veins was negative. Investigation of coagulation revealed positive lupus anticoagulant and d-dimer. Heparin treatment was started. After rehabilitation, the patient was discharged home without sequelae. This clinical case wants to highlight that patients with acute brain injury are at high risk of developing systemic complications and the brain-lung crosstalk is one of the key mechanisms to account.