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Emergency Physician Lands in ED after Subarachnoid Hemorrhage During Bike Ride

By ACEP Now | on March 16, 2016 | 1 Comment
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Emergency Physician Lands in ED after Subarachnoid Hemorrhage During Bike Ride

KK: Were you a good patient and let them do their work? Or did you tell them exactly what was going on and exactly what you wanted done?

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ACEP Now: Vol 35 – No 03 – March 2016

MJ: I was a good patient. I certainly would have put up a fight if I disagreed with them, but I didn’t have to because they had it under control. There was a well-intentioned nurse who walked in and said, “I heard you have a bad headache.” I replied, “It’s a subarachnoid hemorrhage.” That really threw her off guard. She said, “Do you have a history of migraines?” and I said, “No, and this is a subarachnoid hemorrhage.”

KK: The nurse was your first contact when you came in.

MJ: Yes. She was doing what she was supposed to do. I was just a little ahead of her.

KK: Did you have a CT scan or lumbar puncture?

MJ: The doc walked into the room, and I basically told him the short version of what happened. I don’t remember the exact words of the conversation, but he did a very appropriate 30-second exam. Why spend more time? He gave me something for pain and ordered the CT, just like that.

KK: So the CT was positive. How did he deliver that information to you?

MJ: He came in and said, “Your CT scan shows subarachnoid hemorrhage,” matter-of-factly. He already had a plan, which was good. We did have a very good neurosurgeon there at the hospital, Boh Chopko. He said, “I called Chopko, and he’s only going to be here for another week and doesn’t think he should be involved in your care since he’s not going to be here to finish it,” so I was transferred.

KK: How did they fix you? What did they do?

MJ: The very next day, they did an angiogram and saw that there was no aneurysm. There was nothing to fix. It’s what they call a perimesencephalic subarachnoid hemorrhage, also known as a prepontine, which are venous leaks in the brain stem. It often happens to young, healthy folks who are exercising, but they don’t say that exercise caused it, if that makes sense. I saw the attending neurosurgeon the next morning, and I was feeling a lot better. I was thinking, “I’ve got this thing beat. I was looking down the barrel of the gun last night, and now I’m just going to have to hang around the hospital for a couple of weeks.” Then things changed. I got a very severe headache that night. It was 24 hours later. That’s when I was really scared. I was a lot more scared than when it first happened. Knowing that I don’t have an aneurysm, there’s nothing to fix. If the return of my severe headache meant that I was bleeding again, now what was going to happen? What were they doing to do? I was much more scared than when it happened originally.

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Topics: BicyclingCritical CareEmergency DepartmentEmergency MedicineEmergency PhysicianHeadacheImaging & UltrasoundMichael JarosickNeurologySubarachnoid HemorrhageTrauma & Injury

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One Response to “Emergency Physician Lands in ED after Subarachnoid Hemorrhage During Bike Ride”

  1. March 20, 2016

    Michael Jarosick Reply

    Kevin,

    Thanks for the excellent article. Just want to clarify a couple points.

    The onset of head and neck pain were not of “thunderclap” character but there was a massive thunderclap acceleration of the symptoms after that initial 20 minutes. Wow! That acceleration combined with the “worst headache of my life” led me to the field diagnosis.

    Also, in compliance with my neurosurgeon’s advice, I didn’t start mountain biking right away but did very easy pedaling for short distances on flat paved trail until I had his blessing to mountain bike again 1 month later.

    Thanks again, MIKE

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