Acute Neurological Deterioration In a 19-Year-Old Woman: Emergency Recognition of a Complex Frontal Hemorrhage Secondary to the Rupture of a Pericallosal Artery Aneurysm

Abstract

Rupture of a pericallosal artery aneurysm is a rare but highly time-dependent condition, responsible for acute neurological deterioration and significant morbidity. Pericallosal aneurysms account for less than 9% of intracranial aneurysms and approximately 4% of ruptured aneurysms, with a reported mortality ranging between 6.5% and 6.8% in treated cases and a high incidence of complications such as vasospasm and hydrocephalus.We present the case of a 19-year-old woman who, upon awakening in the morning, developed sudden nuchal headache, nausea, loss of consciousness, and subsequent mental status deterioration with aphasia, leftward gaze deviation with left anisocoria and afinalistic limb movements. Multidisciplinary emergency management enabled rapid diagnosis of frontal intraparenchymal hemorrhage, bilateral subarachnoid hemorrhage and tetraventricular hemorrhage. The patient was stabilized, intubated and transferred to the referral neurosurgical center within two hours of arrival.This case highlights the importance of early recognition, prompt imaging and coordinated emergency management to reduce mortality and morbidity.