Abstract
We are reporting the case of a hypertensive middle-aged adult with a triad of right cerebellar hematoma, acute obstructive tri-ventricular hydrocephalus, and spontaneous subarachnoid hemorrhage. A 45-year-old male with a 3-year history of uncontrolled hypertension presented with a severe thunderclap headache, left lower facial weakness, left symmetrical hemiparesis, ataxia, dysdiadochokinesis, signs of intracranial hypertension, grade III hypertension, and a Glasgow coma score (GCS) of 13/15 with a loss of spatial and temporal orientation. A non-contrast-enhanced cerebral CT scan showed a right cerebellar hematoma complicated by a diffuse cerebral edema, a tri-ventricular obstructive hydrocephalus from compression of the fourth ventricle, and a subarachnoid hemorrhage. A conservative management approach was adopted by the neurosurgeon based on the high GCS on entry, slight improvement in the signs of intracranial hypertension and blood pressure, and the lack of a neurosurgical technical platform to manage the case surgically. On his fifth day of admission, he was transferred to the intensive care unit (ICU) following a significant deterioration in his GCS (8/15), despite improvement in his blood pressure (BP) and intracranial pressure. He unfortunately passed away in the ICU 24 h later following a cardiorespiratory arrest. The exact etiology of this extremely rare occurrence remains obscure, and the management is all the more challenging, especially in a setting like ours where neurosurgical services are still underdeveloped. This case highlights the need not only for the establishment of proper neurosurgical services in our setting but also for standardized guidelines for the management of these cases.