Subarachnoid hemorrhage: an unusual presentation of shock

Abstract

A 42-year-old woman became profoundly hypotensive shortly after arriving at our emergency medical center after a seizure. The patient's blood pressure did not respond to aggressive fluid resuscitation, administration of inotropic agents, vasopressors, or corticosteroids. After a thorough search for the cause of shock, she was found to have a subarachnoid hemorrhage (SAH). Hypotension is a rare occurrence in SAH. Several mechanisms of SAH are reviewed in this report and are invoked to explain this patient's lack of response to the standard therapies for hypotension. Emergency physicians should consider SAH in the differential diagnosis of refractory shock in patients who present with neurologic abnormalities.