We report the case of a 41-year-old woman with no history of interest, except hypertension, who presented at home a sudden episode of severe headache in the occipital region, accompanied by progressive decrease in the level of consciousness.
The patient had experienced similar headache episodes in the previous week, albeit of lesser intensity, that subsided with cough.
Emergency services provide care at home, where orotracheal intubation is performed due to a low level of consciousness.
It is urgently managed in a neurosurgical hospital.
On admission, a simple cranial computed tomography (CT) showed a right cerebellar intraparenchymal hemorrhage with a volume greater than 4 cm3, with mild edema and obliteration of the IV ventricle.
It was decided to evacuate the hematoma and place an external ventricular drain.
After surgery, she was admitted to the Intensive Care Unit (ICU).
CTA and cerebral arteriography with no obvious vascular anomalies were performed lately.
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During his stay in the ICU he presents in the first days a torpid evolution due to intracranial hypertension.
After withdrawal of the neurological despise with an adequate level of consciousness and after 48 hours is conscious; in the neurological examination stands out a right hiporreflexia with cutaneous predominance of bilateral extensor facial paralysis, right tetraflexia and quadriflexia.
On the eighth day of ICU admission, the patient was extubated in the morning and remained eupneic throughout the day, with a normal ventilatory pattern.
That same night he begins with hypoventilation that leads to severe respiratory acidosis and secondarily respiratory arrest requiring intubation and MV.
Because of the clinical suspicion of central involvement, magnetic resonance imaging (MRI) of the brainstem was performed, showing secondary changes to the right flare-up of the hematoma, and magnetic resonance imaging revealed no lesions.
Percutaneous closure was decided for invasive mechanical ventilation (IMV), which was particularly necessary at night.
Finally, the patient was discharged to the ward where it is possible to close the symptomatology and continues with non-invasive mechanical ventilation (NIV) with a nasobuccal mask.
