CASE HISTORY

Two and a half years before admission patient had an attack of severe headache with loss of consciousness and was treated. Eight months before admission she had a similar attack. On the day before admission she suffered from severe headaches over the top of her head. This headache recurred during the night and she became drowsy, and finally lost consciousness at 2am on the morning of admission. On admission she was comatose and cyanosed. Her pupils dilated and fixed. Optic discs blurred. Pulse 50, BP 140/90. Lumbar puncture; pressure 300mm of CSF deeply blood stained. The pressure was reduced to 180 mm CSF and patients condition improved. Seven hours later lumbar puncture was repeated and the pressure reduced to 200mm CSF. At 8.30pm her breathing suddenly ceased.

PATHOLOGY

The specimen consists of the basal cerebral vessels. At the point where the right internal carotid artery bifurcates there are two small aneurysms both arising in the angle between two branches. The upper or anterior one is thin and had ruptured at its tip. Giving rise to a fatal subarachnoid hemorrhage. The posterior one is hard and fibrosed due apparently to a previous thrombosis. This may have occurred at the time of one of the patient's previous attacks.