PMC6018894_01
(A) Acute subarachnoid hemorrhage, grade IV according to the Fisher scale, involving the ventricular system. (B) In the M2 segment of the left middle central artery (MCAsin), a 2 mm aneurysm is present (dotted line).
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Olsztyn. In the history, the patient, with no prior history of chronic disease, suddenly experienced severe headache and a loss of consciousness (6 points in the Glasgow Coma Scale [GCS]), was intubated and mechanically ventilated at home, and transported to the Regional Specialist Hospital in Olsztyn. Computed tomography (CT) angiography revealed extensive fresh SAH of grade IV in the Fisher scale, involving the ventricular system (Figure 1), and a 2 mm aneurysmal protrusion on the vascular wall was visualized in M2 segment of the left middle central artery (MCAsin; Figure 1). On admission to the ICU the patient was in critical condition, unconscious with GCS 3 points without analgosedation, with cough reflex, ciliary and corneal reflexes, and pupillary reactivity to light preserved, hemodynamically stable with BP 130/70 mmHg, regular sinus rhythm of 80/min, spontaneous diuresis, and intestinal peristalsis. Following this treatment, gradual improvement was observed with reduction of blood flow velocities, which finally normalized (Figure 2 and Table 1).
Hemodynamic parameters before, during, and after levosimendan infusion. (A) Mean arterial pressure; (B) heart rate; (C) cardiac index; (D) systemic vascular resistance index; (E) central venous pressure; and (F) global end diastolic index.. Note: The arrows indicate days when levosimendan was infused.
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Hemodynamic parameters were monitored with transpulmonary thermodilution (Edwards LifeSciences EV1000 Clinical Platform; the values are presented in Figure 2). Following this treatment, gradual improvement was observed with reduction of blood flow velocities, which finally normalized (Figure 2 and Table 1).