case_images: PMC11380887_01
case_images: (a) Axial view of CT scan demonstrates subarachnoid hemorrhage with left temporal lobar hemorrhage. (b) A three-dimensional contrast-enhanced CT scan shows intracranial artery, with the white arrow indicating the left Internal carotid-posterior communicating (ICPC) ruptured aneurysm.
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case_images: PMC11380887_01_SNI-15-306-g001.jpg
case_images: F1
case_images: A contrast-enhanced computed tomography scan of the head showed a SAH due to a ruptured left internal carotid-posterior communicating artery aneurysm, accompanied by cerebral hematoma (World Federation of Neurosurgical Societies Grade IV, Fisher IV) [Figure 1].
case_images: (a and b) Trans-thoracic echocardiography in diastolic phase and systolic phase indicating diffuse left ventricular hypokinesis with an ejection fraction (EF) of 10-20%. (c) Left ventricular outflow tract (LVOT) velocity-time integral (VTI) shows 7.29 cm, indicating low cardiac output.
case_images: SNI-15-306-g002.jpg
case_images: PMC11380887_01_SNI-15-306-g002.jpg
case_images: F2
case_images: No significant valvular abnormalities were observed [Figure 2].
case_images: (a) Chest X-ray on Day 0 shows a butterfly shadow indicating cardiogenic pulmonary edema. (b) Chest X-ray on Day 3 shows an enhanced shadow in the right hilum, indicating drug-induced pulmonary edema. (c) Chest X-ray on Day 12 shows improvement in pulmonary edema and reduced heart size.
case_images: SNI-15-306-g003.jpg
case_images: PMC11380887_01_SNI-15-306-g003.jpg
case_images: F3
case_images: A chest X-ray examination demonstrated a butterfly shadow and heart enlargement, consistent with cardiogenic pulmonary edema [Figure 3].
case_images: Graph showing daily fluid management. Daily fluid balance goals were set, prioritizing the improvement of pulmonary edema over hypervolemia for cerebral vasospasm.
case_images: SNI-15-306-g004.jpg
case_images: PMC11380887_01_SNI-15-306-g004.jpg
case_images: F4
case_images: Day 1, clazosentan (10 mg/h) and fasudil (30 mg IV infusion every 8 h) were initiated to prevent cerebral vasospasm. Due to the risk of fluid retention associated with clazosentan, daily cardiac ultrasound, chest X-rays, and blood tests were used to determine daily fluid balance goals and manage the patient's condition [Figure 4].
case_images: (a) Cerebral angiography of the left internal carotid artery showing no signs of vasospasm. (b) Cerebral angiography of the right internal carotid artery showing no signs of vasospasm.
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case_images: PMC11380887_01_SNI-15-306-g005.jpg
case_images: F5
case_images: On postoperative day 10, cerebral angiography was performed to assess for cerebral vasospasm, and no significant vasospasm was detected [Figure 5].