gms | German Medical Science

Objective: Subarachnoid hemorrhage (SAH) in children and young adults is uncommon. Especially in patients with head injury it is important not to miss aneurysmal SAH. Even in young patients with SAH treatment can be challenging but outcome may be favourable even with high-grade SAH.

Methods: We here report the case of a drunken (1.5‰ BAC) sixteen year old boy, who collapsed after a school party. He presented with GCS3 to our department. A severe head trauma was suspected. Imaging revealed traumatic subarachnoid hemorrhage without detection of an aneurysm by CT-angiography. Intracranial pressure monitor was implanted. After consolidation of the clinical status the patient underwent cerebral angiography without aneurysm detection. Under SAH-specific treatment intracerebral pressure (ICP) suddenly increased to 40 mmHg after four days. Cranial computer tomography revealed renewed SAH-, right parieto-occipital intracerebral hemorrhage and global cerebral edema. Due to the high ICP we performed immediate decompressive craniotomy followed by second look angiography.

Results: Angiography revealed a very distal Arteria cerebri posterior – aneurysm which was coiled. After the intervention the patient suffered intense vasospasms and was treated with intraarterial nimodipine application. Four weeks later the patient was transferred to a rehabilitation center with severe left hemiparesis. Two years after the insult the bone flap was replaced. The patient showed only a slight hemiparesis and reported aptitude as a drummer as well as an excellent graduation from grammar school.

Conclusions: In conclusion, subarachnoid hemorrhage – even if a traumatic genesis is strongly suggested – demand adequate, potentially repeated cerebro-vascular imaging until the underlying vascular pathology can be definitely excluded.