October 2025 POCUS Case of the Month: Lung Ultrasound
Authors: Ying Hui Low, MD, FASA, FASE; Mitchell Fuller, MD; William Lao, MD
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Question of the Day
A 60-year-old woman with a history of hypertension and diabetes is in the ICU four days after surgical repair of a ruptured cerebral aneurysm. Over the past 2 hours the patient has had become acutely disoriented and drowsy. When aroused she complains of a new headache. What is the MOST likely diagnosis?
Question of the Day
A 60-year-old woman with a history of hypertension and diabetes is in the ICU four days after surgical repair of a ruptured cerebral aneurysm. Over the past 2 hours the patient has had become acutely disoriented and drowsy. When aroused she complains of a new headache. What is the MOST likely diagnosis?
Your Answer
Correct Answer
Explanation
Cerebral vasospasm is a very serious complication that occurs in relation to subarachnoid hemorrhage. This can be seen in up to 35% of patients with cerebral aneurysm rupture. The timing is important for cerebral vasospasm in that it typically occurs 3-10 days after the insult with resolution in 10-14 days. A high index of suspicion must be maintained for this diagnosis in patients with new neurologic symptoms within this time frame and a known subarachnoid hemorrhage. The next most common reason for new onset neurologic symptoms would be rebleed in which case prompt imaging is prudent. Hydrocephalus is also possible and would be visible on imaging. Hyponatremia occurs in patients after intracranial surgery and thus it is reasonable to check electrolyte levels.
