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Case Reports
. 2020 Oct 19;15(4):1050-1054.
doi: 10.4103/ajns.AJNS_183_20. eCollection 2020 Oct-Dec.

Subarachnoid Hemorrhage and Internal Carotid Artery Dissection and Occlusion Following Self-Enucleation

Hadi Joud  1 , Mohammad Hassan A Noureldine  2 , Ivo Peto  3 , Jay I Kumar  3 , Jasmina Bajric  4 , Siviero Agazzi  3
Affiliations
Case Reports

Subarachnoid Hemorrhage and Internal Carotid Artery Dissection and Occlusion Following Self-Enucleation

Hadi Joud et al. Asian J Neurosurg. .

Abstract

Self-enucleation is an uncommon type of major self-injury, which may lead to severe neurological deficits and life-threatening complications, such as subarachnoid hemorrhage (SAH) and internal carotid artery (ICA) dissection and occlusion. Our patient is a 53-year-old man with a history of bipolar disorder and schizophrenia who presented with SAH, intraventricular hemorrhage, ICA dissection and occlusion, and right cerebral infarct following self-enucleation. Despite a Glasgow Coma Score of 6 on initial presentation, he improved with conservative management. He achieved a near-complete neurological recovery, with residual left lower extremity weakness and mild confusion. Self-enucleation is a major neurologic, ophthalmologic, and psychiatric emergency with a potential for serious neurological complications and contralateral visual loss. Yet, conservative management may lead to dramatic recovery.

Keywords: Dissection; internal carotid artery; occlusion; self-enucleation; subarachnoid hemorrhage.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Axial computed tomography head image showing acute diffuse subarachnoid hemorrhage in the frontotemporoparietal and basilar cisterns. (b) Axial computed tomography head images more superiorly showing intraventricular hemorrhage in the 3rd ventricle
Figure 2
Figure 2
(a) Coronal computed tomography angiography image demonstrating occlusion of the right internal carotid artery just distal to the bifurcation of the right common carotid artery. (b) Coronal three-dimensional reconstruction of the computed tomography angiography image in Figure 2a. (c) Lateral digital subtraction angiography with injection into right common carotid artery demonstrating occlusion of the right internal carotid artery near the bifurcation of the right carotid bifurcation
Figure 3
Figure 3
Axial diffusion-weighted imaging image showing a hyperdensity in the right supplementary motor area, indicating an ischemic infarct
Figure 4
Figure 4
Coronal digital subtraction angiography image with injection into the left internal carotid artery demonstrating filling of the right anterior cerebral and middle cerebral arteries through the anterior communicating artery
Figure 5
Figure 5
Repeat axial computed tomography head image on posttrauma day 28 showing a hypodensity in the right supplementary motor area, consistent with a subacute infarct
See this image and copyright information in PMC

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