A 50-year-old-lady presented to our Casualty with altered sensorium following a febrile illness. She was tachypneic and low PO2 with metabolic acidosis in the ABG. GCS was 9/15 with equal pupils and right sided hemiparesis. She had to be incubated and mechanically ventilated. 48 hours after she was hemodynamically stable with fluids and inotropes an MRI of brain was done which showed a left frontal hematoma 5cm diam and a thin left frontoparietal SDH.
An angiogram revealed aneurysm bleed of the left AC branch of MCA. Craniotomy and clipping of the vessel and evacuation of the frontal hematoma was done. She recovered fully after 24 hours and was discharged by the 8th post-op day. In retrospect a CT of the brain may have picked up the aneurysmal bleed.
