case_images: PMC9062947_01
case_images: 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.
case_images: SNI-13-128-g001.jpg
case_images: PMC9062947_01_SNI-13-128-g001.jpg
case_images: F1
case_images: 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].
case_images: 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.
case_images: SNI-13-128-g002.jpg
case_images: PMC9062947_01_SNI-13-128-g002.jpg
case_images: F2
case_images: 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].
case_images: 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.
case_images: SNI-13-128-g003.jpg
case_images: PMC9062947_01_SNI-13-128-g003.jpg
case_images: F3
case_images: 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].