PMC9062947_01
CT head without contrast before lumbar puncture (Pre LP) and 48 h after lumbar puncture (Post LP) demonstrated interval development of intraventricular hemorrhage in the fourth and left lateral ventricle with SAH posteriorly, most pronounced at the vertex.
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F1
A second CT of the head without contrast was completed 48 h after the LP, for sustained headache and development of somnolence, which demonstrated diffuse SAH with intraventricular extension [Figure 1].
MRI lumbar spine with gadolinium: axial cut (left) at L1-L2 and corresponding midsagittal cut (right) demonstrates a large compressing ventral hematoma with maximal thickness at L2-L3 disc space.
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F2
Magnetic resonance imaging of the lumbar spine demonstrated ventral extra-axial hematoma measuring 1.3 cm with compression of the cauda equina most severely at L2-L3 level [Figure 2].
Cerebral angiogram, pre and post intra-arterial vasospasm treatment (a) right internal carotid artery (ICA) frontal projection pretreatment demonstrating moderate-to-severe vasospasm of the M1 and M2 segments of the MCA. ACA demonstrates mild-to-moderate vasospasm (b) right ICA frontal projection demonstrating improved vessel lumen caliber posttreatment (c) left ICA frontal projection demonstrates moderate-to-severe M1 and mild M2 vasospasm pretreatment (d) left ICA frontal projection demonstrating improved vessel lumen caliber posttreatment.
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F3
Patient was started on hyperdynamic therapy and underwent a cerebral angiogram for delivery of intra-arterial spasmolytic therapy, which resolved the radiographic vasospasms [Figure 3].