Hemiparesis Due to Subarachnoid Hemorrhage

An 85-year-old female was found in coma state in a toilet at a public spa area. Her Glasgow Coma Scale in total was 6 and she had isocoric reactive pupil. She had right hemiparesis. The CT examination demonstrated a subarachnoid hemorrhage. Especially subarahnoid hemorrhage at left silvian fissure was thicker than that of right, but no formation of hematoma. The CT angiography revealed a cerebral aneurysm at left internal carotid-posterior communicating artery junction. It was approximately 4 mm in size. She underwent an aneurysmal neck clipping. She complicated cerebral infarction at left putamen and internal capsule due to vasospasm, and right hemiparesis did not improve. Immediate transient vasospastic changes following a hemodynamic insufficient blood supply may have caused the hemiparesis in this case. Some patients with subarachnoid hemorrhage may demonstrate neurological deficits, like those occurring during an ischemic stroke or intracerebral hematoma, so physicians should pay attention to treat such patients gently to avoid the re-rupture of a cerebral aneurysm, especially if the patient has consciousness disturbance.