Subarachnoid Hemorrhage: New Theories, New Treatments

A 62 year-old woman experienced a sudden onset severe headache and collapsed at work. EMS was called and, when they arrived, the patient was awake but confused. She was immediately transported to the ED. The patient had a history of hypertension and was on HCTZ and ACE inhibitor in addition to daily aspirin. On examination, she was somnolent and had sonorous respirations at a rate of 10 per minute. Her BP was 220/110 and the heart rate was 108. Scalp and neck were not tender and there was no meningismus. The right pupil was dilated and the right eye was deviated down and out. No other cranial nerve deficits were noted and the rest of the neurologic exam was normal. Her ECG showed deeply inverted T waves throughout the precordium and in II, III, and aVF.