Funduscopic Findings in Subarachnoid Hemorrhage with Hydrocephalus

Clinical Context

• The American Heart Association recommends that patients with subarachnoid hemorrhage (SAH) and acute hydrocephalus, like this 28-year-old patient, undergo CT confirmation to show blood in cisternal spaces, third ventricle, and lateral ventricles with associated hydrocephalus 1, 2

Funduscopic Findings in SAH

• Intraocular hemorrhage occurs in approximately 10-40% of patients with aneurysmal SAH, manifesting as subhyaloid, intraretinal, or vitreous hemorrhage, according to the American Stroke Association 3, 4

Clinical Implications

• The presence of intraocular hemorrhage in SAH correlates with poor clinical grade and worse outcomes, as stated by the American College of Cardiology 3
• Approximately 40-80% of patients with diminished consciousness from acute hydrocephalus show improvement after CSF diversion, as recommended by the American Heart Association 1, 2

Management Priority

• Immediate neurosurgical consultation for external ventricular drain placement is indicated given the depressed consciousness and radiographic hydrocephalus, as advised by the American Association of Neurological Surgeons 1, 2