Spinal subarachnoid hemorrhage accompanied with intraventricular hemorrhage
In 2010 year A 66-year-old man referred to our hospital because of acute onset paraplegia and incontinency started 3 h before admission. He was referred from a town at about 300 km far from our center. He had been completely healthy until the morning of admission day else slight low back pain since 2 days before. In the morning of that day, he experienced retrosternal chest pain radiating to neck. He had been admitted in local hospital and heparin had been started with diagnosis of unstable angina besides other routine treatment. In the afternoon, back pain had increased and retrosternal stabbing pain had occurred. Some minutes later, right sided lower limb plegia had developed. The physician of the patient called us and we gave admission of the patient. On the way to our hospital, contralateral weakness and incontinency had developed. On admission in our hospital, he was conscious, alert, and oriented. The back pain had been resolved since development of paraplegia and incontinency. On initial physical examination, blood pressure was 180/90 mm/Hg. He had urinary and fecal incontinency. On neurological examination, cranial nerves were completely intact. Funduscopy was normal. On limbs, upper limbs were Medical Research Council (MRC) grade 5 bilaterally but lower limbs were MRC grade 0. Deep tendon reflexes were 2+ on upper limbs but absent on lower limbs. Plantar reflexes were mute bilaterally. There was sensory level at the level nipple (T4). He had severed cervical pain and neck stiffness on neck bending. Bulbocavernous reflex was absent. With impression of spinal hemorrhage, emergent cervicothoracic spinal MRI performed []. On MRI mixed hyper/iso intense lesion in anterior subarachnoid space from C7 to T5 and filling defect in MR myelogram [] was seen. At about 2 h later, brief episodes of apnea happened. After supportive treatment brain CT scan was performed. On brain CT scan, SAH and intraventricular hemorrhage in posterior parts of brain was seen []. SAH management started. In the next morning of the admission day generalized tonic clonic seizure occurred and the patient went to deep coma. Patient was intubated and supported under mechanical ventilation. (please write the results of different biochecmial lab tests) The patient died 10 days later (the cause of death).