PMC9596755_01
(A) Non-contrast CT brain showing extensive subarachnoid hemorrhage centered at the suprasellar and interpeduncular cisterns with cerebral edema. (B) Lactescent subarachnoid hemorrhage was seen during operation (CSF TG level of 6 88 mmol/L), and the corresponding lipemic blood plasma due to hypertriglyceridemia (serum TG level of 52 4 mmol/L). (C) Blood-stained turbid CSF in the tubing connected to the external ventricular drain, day 2 after the operation.
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F1
Computed tomography (CT) scanning of the brain showed an extensive acute subarachnoid hemorrhage at the suprasellar and interpeduncular cisterns, with marked cerebral edema with hydrocephalus (Figure 1A). A burr hole was drilled into his skull and upon dural opening, a lactescent fluid was seen (Figure 1B), which was initially considered purulent, and cerebrospinal fluid (CSF) white cell count, Gram stain, cultures, and serum procalcitonin were subsequently normal, excluding pyogenic meningitis and brain empyema. An external ventricular drain was inserted, and a blood-stained lactescent fluid was drained into the chamber (Figure 1C).
Profiles of serum triglyceride level, CSF triglyceride level, serum total cholesterol, and LDL-C levels with treatment.
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F2
Following endocrine review, intravenous dextrose-insulin infusion, fenofibrate, and atorvastatin were administered, with improvement in TG to <10 mmol/L on day 11 post-admission (Figure 2).