Debilitating Headache after an Excited Reaction

​BY GREGORY TAYLOR, DO, & MATTHEW WARPINSKI, DOA 35-year-old man with a history of uncontrolled hypertension and medical noncompliance was brought to the emergency department by EMS complaining of a headache. The family said the patient was watching football and developed an acute headache after he stood up screaming in excitement.His family said he had not taken his blood pressure medication for years. He was afebrile, his blood pressure was 245/129 mm Hg, his respiratory rate was 18 bpm, his heart rate was 68 bpm, and he weighed 340 pounds. The patient was obtunded with a Glasgow Coma Scale score of 4 and was subsequently intubated.A head CT without contrast showed an acute intraventricular hemorrhage in the frontal horns, occipital horns, third and fourth ventricle extending into the left cerebellar hemisphere with concern for a developing obstructive hydrocephalus. The left cerebellar intraparenchymal hemorrhage measured 4.6 cm x 3.2 cm, with crowding of the foramen magnum concerning for tonsillar herniation. An arterial line was placed, with a blood pressure as high as 349/147 mm Hg. He was maxed out on nicardipine drip, nitroprusside drip, with multiple subsequent intravenous pushes of labetalol.The patient was taken to the operating room where he underwent a ventricular drain placement, craniotomy, and evacuation of the hemorrhage. A repeat head CT showed a significant decrease in the left cerebellar intraparenchymal hemorrhage. The patient continued to deteriora...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research