14th August 2024

You are asked to review a patient on the ward by the neurosurgical team. He is a 37-year-old man

You are asked to review a patient on the ward by the neurosurgical team. He is a 37-year-old man who was admitted with a severe, sudden-onset headache 5 days ago. Admission imaging revealed a subarachnoid haemorrhage secondary to a ruptured aneurysm, for which he underwent endovascular therapy.

He has now been found to be unresponsive despite a recent GCS of 15/15. On the ward round that morning, he had reported feeling entirely back to normal and had mobilised independently.

On examination, his GCS is 8 (E2V2M4). His pupils are equal and reactive to light, and fundoscopic examination is unremarkable.

Which is the single most likely explanation for the decrease in his level of consciousness?

Select the SINGLE most appropriate option from the list below. Select ONE option only.