BACKGROUND: This 42-year-old male presented with subarachnoid hemorrhage of Hunt and Kosnik Grade IV, complicated by neurogenic pulmonary edema, prolongation of the electrocardiographic Q-Q interval, and acute renal failure. METHODS: Surgical clipping was not indicated, so intra-aneurysmal embolization using Guglielmi detachable coils (GDCs) was performed followed by intrathecal infusion of tissue-type plasminogen activator (tPA) via spinal drainage. RESULTS: The patient made a complete recovery 2 1/2 months later except for partial third cranial nerve palsy. CONCLUSIONS: Intra-aneurysmal GDC embolization followed by intrathecal tPA via spinal drainage is an excellent method for treating aneurysms that are difficult to treat surgically.
BACKGROUND: This 42-year-old male presented with subarachnoid hemorrhage of Hunt and Kosnik Grade IV, complicated by neurogenic pulmonary edema, prolongation of the electrocardiographic Q-Q interval, and acute renal failure. METHODS: Surgical clipping was not indicated, so intra-aneurysmal embolization using Guglielmi detachable coils (GDCs) was performed followed by intrathecal infusion of tissue-type plasminogen activator (tPA) via spinal drainage. RESULTS: The patient made a complete recovery 2 1/2 months later except for partial third cranial nerve palsy. CONCLUSIONS:Intra-aneurysmalGDC embolization followed by intrathecal tPA via spinal drainage is an excellent method for treating aneurysms that are difficult to treat surgically.