title: Transient hemiparesis due to a ruptured cerebral aneurysm in the prehospital setting.
abstract: A 67-year-old woman developed a sudden onset headache and left hemiparesis. Emergency medical technicians found that she was conscious, but had left hemiparesis. On arrival, she had an isolated headache without any neurological deficits, however, suddenly became comatose during a head CT examination, which demonstrated a subarachnoid haemorrhage. The head CT angiography on the second day revealed a cerebral aneurysm at the right middle cerebral artery, which was clipped on the same day. The patient demonstrated left haemiplegia and total aphasia after the operation, however, the neurological deficit gradually subsided and discharged on foot in 4 months without any deficits. Some patients with a subarachnoid haemorrhage may demonstrate transient neurological deficits, like those occurring during an ischaemic stroke, so emergency medical technicians and physicians should pay attention to treat such patients gently to avoid the re-rupture of a cerebral aneurysm, especially if the patient has headache symptoms.
authors.affiliation: Department of Emergency and Disaster Medicine, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan. yyanaga@juntendo.ac.jp
authors.forename: Youichi
authors.initials: Y
authors.lastname: Yanagawa
authors.forename: Kazuoki
authors.initials: K
authors.lastname: Hirano
authors.forename: Arisa
authors.initials: A
authors.lastname: Hayashida
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nakazato
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D010291:Paresis / Q000209:etiology*; D012074:Remission Induction
references.citation: Acta Neurol Belg. 2012 Sep;112(3):291-3
references.pmid: 22565778
references.citation: Brain. 2001 Feb;124(Pt 2):249-78
references.pmid: 11157554
references.citation: Acta Neurol Taiwan. 2008 Jun;17(2):94-8
references.pmid: 18686648
references.citation: J Am Med Dir Assoc. 2000 May-Jun;1(3):129-31
references.pmid: 12818026
references.citation: J Neurosurg. 1970 Jun;32(6):617-25
references.pmid: 5429519
references.citation: J Med Assoc Thai. 2004 Jul;87(7):845-9
references.pmid: 15521244
references.citation: Arch Neurol. 2002 Jun;59(6):977-81
references.pmid: 12056934
references.citation: AJNR Am J Neuroradiol. 2011 Nov-Dec;32(10):1862-5
references.pmid: 21868623
references.citation: Clin Neurol Neurosurg. 2012 Jul;114(6):689-90
references.pmid: 22169066
references.citation: Curr Treat Options Neurol. 2013 Feb;15(1):13-27
references.pmid: 23203776